«! 41] 1 -JCJ hi a.UVAN< 1 ir^ PIV .WHfllTA^ ^TiiiDNVSOl^ }SANGEL£j^ ^^1-L1BRARY(9/ % ^^ '^mmy\^^'' oFCAilFO% 'om'^^{^- LIBRARY^:^^ ^^WEUNIVE IVER% PRELIMBARY EEPORT OF THE IN PORTO RIl'O. Authorized by Act of the Legislative Assembly, Approved March 8, 1905, to coutinne the work of the Commission for the Stiulv and Treatment of Anemia in Porto Rico^ Respectfnlly submitted to THE HONORABLE BEEKMAN WINTHROP, Governor of Porto Rico. JAXIARY 1, 1006. BUREAU OF PRINTING AND SUPPLIES, San Juan, P. R. ERRATA. Page 11. Page 11. Page 15, Page 15, Page 21, Page 28, Page 28, Page 28, Page 35, Page 51, Page 51, Page 51. ne 19; Read •■18+5;'^ instead of ■■2H+r;" . ne 21; Read '72+5;" instead of -^n+f. ne 84; Read, Uncla.ssified, Under treatment. •2' instead of nothing. ne 34; Read, Unclassified. Total. -175" instead of "ITS". ne 26; Read ■Uuelnaria" instead of "Uncinariasis''. ne 9; Read "92.3'>i"' instead of "QO.l/jt" ne 11; Read '-97.55^" instead of "95.28!{". ne 13; Read "99.06^" instead of "96.57^". ne 24; Read "$23,766" instead of •622,766 '. ne 24; Read "234.41" instead of "226.91". ne 26; Read "203.73" instead of "196.23." ne 28; Read ■239.26" instead of "231.76." LETTER OF TRANSMITTAL. Aibonito, P. R., January 1, 1906. Sir : — We have the honor to transmit hereu'ith a preliminary rejiort of the transactions of this Commission, from June 1, to November 30, 1905. In it xve have discussed, with as little technical phraseology as possible, the results obtained, our observations, and recommendations regarding Uncina- riasis in Porto Rico. Although this report includes only our operations to November 30, the work at all stations has continued tminterruptedly, and we hope to be able to support them with the present appropriation until February 1, 1906. It is the intention of this Commission to publish at a later date, a more complete report including the results of certain studies of 2Jiirely scientific nature, observations drawn from work in the clinic, hospital, and laboratory. Respectfully, Pedro Gutierrez Igaravidez, 31. D. W. W. King, 31. D. Passed Assistant Surgeon, U. 8. Public Health and Marine Hospital Service. Bailey K. Ashford, M. D. Captain, Assistant Surgeon, U. S. Army. Honorable Beekman Winthrop, Governor of Porto Rico. AN ACT To continue the work of the Commission for the suppression of Anemia in Porto Rico, and making appropriation therefor. Be it enacted by the Legislative Assembly of Porto Rico: Section 1. — The sum of fifteen thousand dollars, or so much thereof as may be necessary, is hereby appropriated out of any moneys in the Treasury not otherwise appropriated, for the purpose of continuing the work of suppressing the disease known as uncinariasis in Porto Rico. Section 2. — The said appropriation shall be expended under the direc- tion of the Governor of Porto Rico for the necessary expenses of carrying on the work, establishing hospitals, purchasing medicines and supplies, and the employment of the necessary physicians, nurses and other employes. Section 3. — The Governor is hereby authorized, if he deems best, to use as a hospital, either or both of the barracks constructed at Humacao and Jayuya, for the convict labor on the road work. Section 4. — This act shall take effect from and after its passage. Approved March 8, 1905. BRIEF ACCOUNT OF THE WOEK OF THE COMMISSION. This Commission was originally appointed in March, 1904, and from that time until August of the same year, treated 5,500 eases of anemia to determine to what extent the uncinaria was responsible for the large number of anemics in Porto Rico, and what other causes existed; to demonstrate the practicability of curing them on a large scale at comparatively small cost; and to study the disease itself and the conditions in Porto Rico, with a view of preventing its spread. The results of these labors, published as "Report of the Commission for the Study and Treatment of 'Anemia' in Porto Rico," dated December 1st, 1904, were of such importance that the Legis- lative Assembly, at its next session, appropriated $15,000 to continue the work, and the Governor of Porto Rico reappointed the members of the former Commission to take charge of it, forming what is known as the "Porto Rico Anemia Commission." As the Commission had advised in its Report two practical methods of attacking the disease, the question now confronting it was to put into actual practice the measures advocated. Estimates for an extensive campaign were made and orders were placed for medicines and supplies which, on account of the large quantities needed, had to be purchased from wholesale houses in the United States. In this, there was also the advantage of obtaining goods at wholesale prices. In the meantime, plans were made for the organization of a central station and several substations, the number of which was not determined until we could begin operations and learn how much could be done with the amount at our disposal. The Commission desired to locate its headquarters in some place in the mountainous interior where the disease is most prevalent; central to a large territory to be covered by the various stations; on one of the main thorough- fares and with reasonable facilities for transportation; where the municipal authorities would lend their moral support; and where no work of this kind had been done, so that we could see what could be accomplished in an en- tirely new field. Aibonito was suggested as a suitable location, and, during a visit of inspection, a site for the station was selected, an unused road house on the military road some distance from the town. It was in need of exten- sive repairs and renovations toward which the Municipality of Aibonito offered to appropriate $100. The generous offer was accepted and the Com- mission moved to Aibonito early in May to superintend the preliminary re- ANEMIA IN PORTO RICO. pairs and additions that were needed. These repairs, etc., were not completed nntil the second week in June but were sufficiently advanced to allow us to open the outdoor clinic on June 1st. The hospital tents and equipment which had l)een stored in Utuado since the termination of the work of the previous year, were transported to Aibonito and erected in the field inunediately in the rear of the building occupied by the Commission. They were arranged in a curved line follow- ing the crest of a sloping hill. In one corner of the field, a camp kitchen was built, while two other corners were occupied by latrines, one behind each end tent. Tiie latrines were constructed on approved sanitary lines, using the pail system. The slope of the hill made it convenient to remove the cans from the rear and rendered it unnecessary to dig any pits, the cans simply being placed on a cement floor to prevent contamination of the earth. Patients first entered the examining room where their feces were sub- jected to microscopic examination. If it was the first visit, the history of the case was entered on the clinical card bearing a serial number; a smaller identification card numbered to correspond was given to the patient to be presented on sul)sequent visits. By means of this smaller card, their history could l)e easily found in the file, and notes as to condition, treatment, etc.> added at each visit. To new patients a few plain words were said in explan- ation of their disease, how they contracted it, and how to prevent reinfec- tion. Specimens of the parasite were shown them, and a small pamphlet containing the same explanations was given to those who could read or had anyone to read it to them. These pamphlets were also distributed through- out the district by the Insular police stationed at Aibonito, when making their rounds through the country. Each patient was asked if he had a la" trine at his home, and in case of a negative answer, as nearly all were at first, he was enjoined to construct one immediately. It soon became com- mon to hear new patients say that they had already complied with these in- structions, having been told to do so by others who had been to the clinic. That the vast majority of our patients did obey, we have not only their own word but the evidence of plantation owners and others in the country, and more particularly the reports of Policeman Joaquin Sanchez who was de- tailed for duty as inspector for the Commission. His inspections covered every barrio of Aibonito and some of other municipalities from which we received a considerable number of patients. He made reports on the con- struction of latrines, conditions in the barrios, assisted very ill patients to reach the hospital, and performed duties of similar nature. He appreciated the responsibilities of his work as he himself had been a sufferer from a severe grade of the disease, and was cured by the Commission during the previous year at Utuado. Although no special announcement was made of the opening of the ANEMIA IN PORTO RICO. 9 station, a glance at Table 12 will show how patients came in increasing num- bers until the Commission saw itself obliged to secure the services of Dr. E. Canino, of San Lorenzo, and Dr. Manuel Dueiio, of Bayamon, as Assistants to the Commission. The latter resigned November 10. The attendance of the patients on the clinic naturally fluctuated l)ut the majority of them came quite regularly at intervals of a week or two, accord- ing to the medicine they received. Those from a long distance were given sufficient for the longer interval. Saturday was always the busy day, the number of visits exceeding five hundred on several occasions. The clinic was closed on Sundays, no out-patients being treated except sometimes one or two who had come a long distance in ignorance of this rule. The table of visits has been compiled by weeks, thus giving a good idea of the work of the station without the tediousness of a daily record with its unimportant variations. The tent hospital of sixty beds was ready for occupancy by June 1 5. In it were placed patients suffering from severe grades of the disease, and some who, though not gravely ill, had come distances too great for them to return at intervals for the medicine. The hospital also afforded an oppor- tunity to keep under observation cases presenting special symptoms or com- plications, and those on whom special investigations were being made, as the series of cases used to observe the effects of the anthelmintic drugs. From June 15, to November 30, 205 patients were admitted for varying lengths of time aggregating 7,137 days of hospital treatment. Very interesting and valuable observations have resulted from the labora- tory investigations on the relative effect of the medicine used, analyses of urine, pathological anatomy, etc., but as these studies belong more to the discussion of the medical side of the question, they will be considered at length in a later report. By that time we hope to have finished the laboratory work now in progress and some that we contemplate doing. We are indebted to Dr. Francisco Sein, of Lares, and Dr. Rafael Cesteros, of Guayama, for specimens from autopsies performed at their stations. As soon as the Central Station at Aibonito could be thoroughly organized and put in good running order, we turned our attention to the establishment of substations at several towns which had requested our aid. The first was opened July 15, at Lares, under the charge of Dr. Francisco Sein of that town, and from time to time others were opened as fast as arrangements could be made to do so. Even after we had placed in operation the six substations, all that we believed possible to maintain with our limited resources, various municipalities requested similar ones but unfortunately we could do no more than offer the medicines. Indeed San Sebastian asked for medicines alone. Under these conditions, four additional substations at San Sebastian, Barros, Moca and Patillas were 10 ANEMIA IN PORTO RICO. established. The latter, however, was opened so late in November that practically no work was done in the time embraced by this report. The physicians who were to take charge of the substations were invited to visit the Central Station at the expense of the appropriation, to observe the methods of working, manner of keeping records, etc., thus insuring uniformity in the data obtained at the various stations. This system of substations was somewhat of an experiment and its success has been one of the most gratifying results of the years work. It proves the feasibility of establishing a number of stations in various parts of the Island, which will work in harmony under a central direction. We acknowledge with pleasure that the credit belongs more to the directors of these stations than to the Commission which exercised only an administrative function toward them. Their statistics have been tabulated with those of the Central Station for the purpose of showing the combined results of all stations. The directors of substations were also requested to submit a few remarks on the work in their districts together with any considerations that they might wish to make upon the subject generally. Their opinions without alteration or comment have been inserted in this report under the heading, " Reports from Substations. " For sake of convenience, we have grouped the statistics at the end of this report, and only insert here summaries of various tables as we discuss the conclusions which may be drawn from the facts they contain. The disease is one to wliich the white and mixed races are predisposed, having always in mind, however, the possibility of encountering serious symptoms in the infected negro. We were working in a part of the Island where the negro is relatively rare, with exception of two substations. SUMMARY OF TABLE 4. SHOWING THE COLOR OF ALL PATIENTS IN RELATION TO THE CLINICAL TYPE OF UNCINARIASIS. Type of uncinariasis Very light Light Medium Intense Very intense L'nelassified Total.. White 946 3,061 7,135 3,034 384 101 14,661 Mulatto 349 1,111 1,343 427 48 62 3,340 Not Negro recorded Total 83 1,378 311 _ 4,483 228 8,706 40 3,501 8 440 12 182 357 682 182 18,865 18,865 ANEMIA IN PORTO RICO. 11 SUMMARY OF TABLE 5. SHOWING THE RELATION BETWEEN THE COLOR OF ALL PATIENTS TREATED AND THE RELATIVE NUMBER OF UNCINARIA OVA FOUND IN THEIR STOOLS ON MICROSCOPIC EXAMINATION. Relative number ova imcinaria White Mulatto Negro Not recorded Total Great many Manv 330 4,330 5,665 2,696 198 60 958 1,355 873 43 13 142 360 153 5 . . 173 403 5,430 7,. 380 3,722 246 173 Moderate. Few Very few Unclassified Total 13,219 3,289 673 173 17,354 Plus substation, Barranquitas (no microscope) " Moca " " 1,425 86 Ora-vt ) Total 18,865 18.865 From the summary of Table 4 we see that 78+^ of 18,865 jjatients were white, 28+^ were mulattoes and only 3+^ were negroes. Of the total number of 14,560 whites treated, excluding those in which the type of the disease was not stated, 71+^ were medium, intense, or very intense cases, while only 41-]-^ of the 670 negro patients fall in this classifi- cation. On the other liand, from the summary of Table 5 we find that the white patients in whom a moderate, large or very large number of eggs of uncinaria were observed in the stools, form 78+^ of the 13,219 whites treated, and that 76-f ^ of the 673 negro patients fall in tliis classification. In other words, the negro is just as heavily infected, just as dangerous to the community in which he lives, as the white man, but he possesses a re- lative immunity to the effects of the parasite. The ages of our patients are graphically portrayed in the following summaries of Tables 6 and 7. ANEMIA IN PORTO RICO. SUMMARY OF TABLE 6. SHOWING THE RELATION BETWEEN THE AGES OF ALL PATIENTS TREATED AND THE CLINICAL TYPE OF UNCINARIASIS THEY PRESENTED. Type of Uncinariasis Years of Age U5 us 03 a o o o cr- o o CO o o o u ? c -3 O o u ■ o 'a o Very light. . . Light Medium Intense Very intense. Unclassified.. 28 77 82 43 4 6 216 628 830 235 30 20 371 1,049 1,905 650 63 25 489 1,682 .3,587 1,458 179 74 220 822 1,844 859 112 34 39 153 311 179 30 9 13 60 142 68 21 6 2 12 5 9 1 183 1,378 4,483 8,706 3,501 440 357 Total.... 240 1,959 4,063 7,469 3,891 721 310 212 18,865,18,865 SUMMARY OF TABLE 7. SHOWING THE RELATION BETWEEN THE AGES OF ALL PATIENTS TREATED AND THE RELATIVE NUMBER OF UNCINARIA OVA FOUND IN THEIR STOOLS ON MICROSCOPIC ^EXAMINATION. Relative number Y^ears of Age ova uncinaria. ifl c >-i 03 ■* Ol Si 0-. O O c^ ■^ i-*? Qi o o o o ^ o CO -*^ hi lo o 2 o CO o > C o o Very few 7 41 62 87 37 7 5 246 Few 61 487 762 1,516 715 124 49 8 3,722' Moderate .... 125 811 1,691 2,915 1,378 289 157 14 7,380 Many 33 425 1,104 2,222 1,335 239 65 7 5,430; Great many. . 1 20 93 146 111 22 9 1 4031 Unclassified.. 173 173 Total 227 1,784 3,712 6,886 3,576 681 285 203 17,354 Plus su bstatic )n Barranqui tas, (no microscop e) 1,425 86 Moca GKAxn T( JTAL. . 18,865 18,865 ANEMIA IN PORTO RICO. 13 From this we see that 72-|-^<^ of all our patients were under thirty years of age (!). Two facts should be borne in mind in the consideration of these last four tables: 1. The degree of the disease was estimated by the clinical signs and symptoms. Here in Aibonito, at least, cases classed as "medium" would be considered as severe in the United States and in Europe. 2. The same observation may be made with regard to the estimate made of the number of eggs of uncinaria per field of the microscope (num- ber 4 eye-piece and 3 objective, Leitz). "Moderate" signifies from two to five eggs per field. The results of treatment are summarized from Tables 8 and 9 as follows: SUMMARY OF TABLE 8. SHOWING THE RESULTS OF TREATMENT OF PATIENTS, CLASSIFIED ACCORDING TO THE CLINICAL TYPE OF UNCINARIASIS PRESEiNTED. Type Cured Under treatment Died Total Very light. . . . Light 518 1,449 2,747 1,091 110 82 860 3,033 5,949 2,382 304 100 1* 10 28 26 2 1,378 4,483 8,706 3,501 440 184 173 Medium Intense Very intense. . LTnclassified. . . Not recorded . . Total 5,997 12,628 67 18,865 Grand Total, 18,865 * Case 5,128 had a light grade of uncinariasis but came to our clinic with advanced tuber- culosis from which he died. At the close of the chapter devoted to the prevention of uncinariasis, an explanation of the expression " under treatment" is made. Suffice it to say, that fully 10,000 (estimated) of the 12,628 persons, classed as under treat- ment, are practically cured, which with the 5,997, gives an estimated 84-)-^ cured. Our death rate has been phenomenally low; only ^-\-^ of the total number. Most of these deaths were due to other causes. A fair estimate of what has occurred at the various substations may be seen in the following table of deaths occurring among the 6,152 patients treated at the Central Station, Aibonito: 14 ANEMIA IN PORTO RICO. DEATHS. CENTRAL STATION, AIBONITO. Date Case. admission. Date death. Municipality. Cause. 18 June 2 July 14 Morovis Chronic parenchyma- tous nephritis. 296 June 8 June 15 Aibonito Chronic uncinariasis. 966 June 18 July 15 Barranquitas Chronic enteritis. 1182 June 22 Oct. 18 Aibonito Gangrene lower ex- tremities, due to ' extreme edema of uncinariasis. 1315 June 24 July 7 Barranquitas Dilatation heart due to uncinariasis. 1990 July 9 Oct. 19 Aibonito Chronic nephritis. 2504 July 27 Aug. 4 Barranquitas Pulmonary tubercu- losis. 2606 ' July 28 Oct. 19 Aibonito Chronic amebic dysen- tery. 2668 July 29 Aug. 16 Barranquitas Dilatation of heart due to uncinariasis. 3325 Aug. 18 Oct. 29 Coamo Chronic dysentery. 4194 Sept. 9 Oct. 20 Cidra Tuberculosis of the larynx. 4661 Sept. 20 Nov. 4 Cidra Uncinariasis. 5128 Oct. 3 Oct. 30 Aibonito Pulmonary tubercu- losis. 5177 Oct. 1 Oct. 30 Cayey Uncinariasis. All deatlis whose cause is noted as due to diseases other than uncinari- asis, save case 5,128, were complicated by an intense or very intense grade of uncinariasis. ANEMIA IN PORTO RICO. 15 The following is a summary of the number of doses of anthelmintic administered and the number of times eacli case received the drug: SUMMARY OF TABLE 9. SHOWING THE RESULTS OF TREATMENT OF PATIENTS, CLASSIFIED ACCORDING TO THE NUMBER OF DOSES OF THE ANTHELMINTIC ADMINISTERED. Doses anthelmintic. One Two Three Four Five Six Seven Eight Nine Ten Eleven Twelve Thirteen Fourteen Fifteen Sixteen Seventeen. . . . Eighteen Nineteen Twenty Twenty one . . Twenty two. . Twenty three. Twenty five. . Not stated. . . . Unclassified . . Total. Cured 17 195 981 ,085 882 651 509 459 352 271 191 145 94 61 34 35 17 7 6 4 Under treatiiieut 2,182 2,5.54 1,741 1,701 974 1,102 601 549 334 329 186 153 63 60 31 20 17 11 8 2 2 1 2 1 2 5,997 12,628 Died 67 Total 2,220 2,769 2,736 2,793 1,860 1,753 1,110 1,008 686 601 377 298 157 121 65 55 34 18 14 6 2 1 3 1 2 173 18,865 Grand total doses of anthelmintic. 89,908 18,865 16 ANEMIA IN PORTO RICO. Attention is invited to Table 1 which is summarized as follows: SUMMARY OF TABLE 1. GIVING TOTAL NUMBER OF PATIENTS FROM I:ACH OF THE MUNICIPALITIES REACHED BY THE COMBINED WORK OF ALL STATIONS. Municipality of Aibonito " " Barranquitas. Barros Comerio Coamo Utuado Guayama San Sebastian. Moca Lares Cidra Cayey Morovis Caguas Naranjito Aguas Buenas. Salinas Corozal Fajardo Ciales San Juan Arecibo Juana Diaz. . . . Santa Isabel. . . Bayamon Ponce San Lorenzo. . . Patillas Arroyo Hatillo Adjuntas Las Marias. . . . Camuy Total. 774 868 550 644 531 058 623 746 86 ,457 694 190 81 5 122 26 13 17 1 19 2 67 7 8 18 3 2 104 8 27 94 14 6 18,865 A consideration of this summary permits the following deductions to be drawn : 1. In those municipalities possessing a station of the Commission (first ten of the summary), the work of treating infected persons ANEMIA IX PORTO RICO. 17 has been actively prosecuted. In most of them the prophylactic value of this work is enormous, as seen from the large numbers treated. 2. In others, such as Cidra, the campaign has reached such propor- tions that it offers every assurance of a like result. 3. In all others, generally far from the stations, the value of the work is being made the subject of general conversation among the laboring classes, due to the cures effected in individuals from such municipalities who sought treatment. It may be con- fidently expected, when a number of persons from them has been cured, that all these municipalities will begin to demand a station of their own, so overwhelming is the propaganda made by those who have the evidence of their personal experience to lead them to speak. The following is a summary of Table 2 : SHOWING NUMBER OF VISITS MADE BY PATIENTS TO THE CENTRAL STATION AT AIBONITO, ARRANGED ACCORDING TO THE MUNICIPALITY FROM WHICH THEY PROCEEDED. Municipality. Number Visits. Aibonito 16,095 2,207 879' Barros Comerio 603 Coamo 1,935 Cavev 522 •Cidra 2,271 Morovis 2 Caguas 6 Naranjito 25 Aguas Buenas 16 Salinas 26 Corozal 11 Utuado , 5 San Juan 6 Arecibo 1 Juana Diaz 9 Fajardo 2 Ciales 1 Santa Isabel 6 Grand Total 24,628 18 ANEMIA IN PORTO RICO. This summary shows how relatively little the distance operates to deter the jibaro from pursuing a treatment once begun. The number of patients from each munici|)ality who made these visits will be found detailed in the Table referred to. SUMMARY OF TABLE 12. SHOWING TOTAL NUMBER OF VISITS MADE BY PATIENTS TO THE VARIOUS STATIONS. Stations. Patients beginning treatment. Aibonito Barnvnquitas . Barros . Coamo Comerio Guayama . . . . San Sebastian Moca Utnado Lares 6,152 1,425 1,255 1,048 1,676 746 663 86 1,813 4,001 Patients returning for treatment. Total Vi-sits. 18,476 6,113 5,536 4,730 7,830 1,223 1,419 105 3,841 8,272 18,865 57,545 24,628 7,538 6,791 5,778 9,506 1.969 2,082 191 5,654 12,273 76,410 Persons in whose feces no eggs of imcinaria were found. This data only recorded in Central Station 486 Total. 76,896 The enormous number of visits shown by summary of Table 12, in each, of which personal cognizance of the patients condition and progress was taken,* a microscopic examination of his feces made, and an appropriate prescription written and despatched, record being made on the history card kept on file, as before described, demonstrates what a immense work it is possible to accomplish, proceeding along the lines laid down by the Commission for the present year and recommended on a larger scale for the future. A most important fact is elicited from a consideration of Table 3, where the residence of patients attending the Central Station is detailed by consecu- tive thousands. It has been said that the jibaro seeks novelty and the air of mystery pervading a clinical laboratory in which many strange instruments are grouped about the patient, and many examinations of his blood, feces, etc. are made. While not discounting the human trait that may be attributed to all people under such circumstances, the Commission is persuaded that the ANEMIA IN PORTO RICO. 19 jibaro is not actuated to any great extent by such motive in his long tramp from some distant mountain barrio. It is his heahli he seeks. As proof of this, a reference to this table should be made. When we began to receive patients at the station in Aibonito, and for at least two montlis thereafter, no other station existed within reach of the people of Barranquitas, Barros, Comerio, Cidra and Cayey. An ever increasing number from these munici- palities swelled our clinic. In August, we established substations in Barranquitas, Comerio and Barros. At these stations no laboratory, properly speaking, existed, only the excellent doctors who took up the work at those places and the neat little offices fitted up by their own personal efforts, forwarded by the enthusiastic municipal authorities. At once our patients from those municipalities began to fall away from the Central Station. They knew that the same treatment was being employed at those points, they were kindly received there and their chief object, to get cured, was satisfied. In tlie meantime, the number from Cayey, and especially from Cidra, where no stations could be established, kept steadily increasing, although both are far distant and consume at least an entire day in the trip to Aibonito. So we see that it is the opportunity to regain their health that attracts them, not novelty. The effects produced by the drugs, thymol and beta-naphthol, have been carefully studied by the Commission. Their relative value is discussed in the chapter on prophylaxis. Botli are excellent in their results and each has special uses which, together with the compilation of our data on this subject, will be fully discussed in a future report. Suffice it to say, that the repeated use of tliese anthelmintics weekly for two or three months in cases which have suffered from intense anemia is not advised. Beta-naphthol in such cases may, by adding the element of irritation to a kidney already profoundly diseased, aggravate the existing process. Tliis is by no means believed to be a contraindication to its general use but it should be considered in a small proportion of cases. Thymol is far less irritating and our belief is that five consecutive doses of eitlier is sufficient, usually, to bring the patient, if not to a technical cure, at least to the assurance of a practical cure. After this he can be instructed to return for further treatment at the end of a month when if need ])e the vermifuge may be repeated. Thus we see that the specific treatment of " Porto Rican Anemia" is a fact established beyond all quibble or question. The long list of " sure-cure" patent iron pills, powders, and blood and nerve restorers, so dearly paid for by the unfortunate and credulous "jibaro," paid for, it should be remem- bered, from the earnings of a class said to be starving in poverty, is a list too long and too disgusting to contemplate without anger and a sense of shame. Its length is sufficient guarantee of the utter inefficacy of any 20 ANEMIA IN PORTO RICO. one of such preparations to cure, for had any particular one of the marvel- lous fabrications been true, all others would have sunk into oblivion. As it is, all has-e prospered, enriched by the sweat of thousands who spend an immense quota of their savings to reap a bitter disappointment in broken promises of health and vigor. We believe that no more startling instance of the pernicious custom of trusting to patent medicines exists than in the exceedingly interesting liistory of the recovery in Porto Kico by Scientific Medicine, by the Doctor, of a territory exploited by commercialism, the innocent faith of the poor "jibaro." In regard to iron and all iron preparations, let it be said that the Com- mission has well nigh abandoned its use even in the presence of Sfc of the blood value of a patient with uncinariasis. Many of our Directors are coming to adopt the same position, and, as the work goes on, as they become familiar with the relatively small value of iron, they are gradually drop- ping its use, where previously it was, as it was with us, a sine qua non in the treatment of uncinarial anemia following specific medication. We will not now discuss tliis question but we u'ill have a great deal to say upon it in a future professional report where some very interesting com- parisons will be made between cases in which iron was given after specific anthelmintic treatment and cases where no iron was used. The subject is referred to and emphasized because the eager throng of vendors of patent ferruginous tonics is pressing in to recommend their preparations basing their supposed value upon a previous report of this Commission, on which no very different constructiou can be placed from that just expressed. We do know the relative value of iron in uncinariasis. It is of some value but its value is the same in the after-treatment of this disease as in the treatment of malaria or syphilis. Lack of space forbids us to acknowledge individually the services and moral support of the thousands of friends of this work. Besides those whose active part has contributed so much to its success we desire to express our deep appreciation of valuable services rendered the Commission by the pharmacist of Aibonito, Licenciado Senor Don Teodoro Moscoso. The Commission wishes to acknowledge the interest and assiduity with which its assistants at the Central Station, Doctors E. Canino and Manuel Dueno fulfilled the arduous duties devolving upon them. THE PEEYENTION OF UNCINAEIASIS IN PORTO EICO. Hoic does infection take place f The Commission, as a result of its two years of investigation, has come to the conclusion that, if not in all, at least in 99^ of all those who harbor uncinaria in their intestinal canal, the parasite effected its entrance into the body through penetration of the skin in contact with soil or water loaded with the young larvae. In other words, we now know that the bare-footed laborer in infected soil who contracts the characteristic "Ground-itch" or " Mazamorra," so familiar to every shoeless individual on the Island, is in- vaded by uncinaria. In brief, the sequence of events is as follows: — The parasite lives in the intestine of man. An ordinary case of uncinariasis, such as we see so frequently here, produces over a million eggs a day which are laid by the female worms in the upper part of the small intestine and become well mixed with the feces. These feces, deposited under proper conditions of shade, moisture and temperature, always to be found in Porto Rico, give rise, upon the hatching of the eggs, to imiumerable, minute young worms, the larvae, which await the opportunity to penetrate the skin of man and travel to his intestine, their final and natural home. Very fortunately, these larvae cannot reproduce their species outside of the human body nor do they live indefinitely in the earth although we have not yet been able to define their limit of natural existence. When one harbors but few worms, the symptoms of infection are usually few or absent entirely and the individual is much less dangerous to the community in which he lives than he who is sick or ailing from a large number. Mazamorra is the first sign of infection by Uncinariasis and if severe or repeated attacks take place, Uncinariasis will follow. Uncinariasis is that condition resulting from infection by uncinaria in sufficiently large numbers, to overcome a mans resistance to the poison elab- orated by the parasite resident in the intestinal canal, a poison whose effect is manifested by certain notable disturbances in the functions of vital organs. While frequently the symptoms are confined to a general reduction in strength, dizziness, and vague pains in chest and stomach, without notice- able pallor, is it only too common to observe a more or less grave alteration of the blood, resulting in that symptom of advanced uncinariasis which the ANEMIA IN PORTO RICO. layman ha^? so much reason to fear and respect from years of dread exper- ience, "Anemia." This is the lamentable condition which some continental newspapers have been pleased to call, " The Lazy Disease." From this point it is but a step to general "dropsy," failing heart and the miserable extinction of a man in his prime, preyed upon by a parasite easy to expell ; of a man, the victim of his own incredulity and that of those who surround him, with respect to laws founded upon a\ hat may be termed tlie mathematics of our profession. Thus we know that tlie long-time curse of Porto Rico, its "Anemia," is a disease, not an expression of an insufficient or improper diet, no matter how evident the poverty and wretchedness of thousands of poor on tliis Island. With regard to the latter, we as medical men may deplore but cannot help such conditions wherever they may exist. With the former, only physicians and sanitarians can successfully deal. Therefore, whether very ill or apparently well, everyone infected by uncinariae is a menace to the public health, for if he defecates upon the earth where others must tread he stocks it with a numerous progeny which maturing will seek another human host, perhaps one of his own family. As evidence in part for our decided views with regard to skin infection, we refer to the fact that only ■i-\-fo of all whom we found infected denied having had mazamorra. Even among this small number of persons, many will be found who either forgot that they had had it or who did not care to mention it for fear of humiliation. The correctness of both of these supposi- tions we have had ample opportunity to prove. Moreover, in 486 persons who presented themselves for treatment in Aibonito and in whom neither eggs of uncinaria were found nor anemia present, only 234 stated that they had had mazamorra and generally such persons had suffered from it at a period so remote that all worms had long ago come to the end of their natural existence, or, in other words, had died of old age. All other routes of inl'ection are rarities, at least in Porto Kieo, and do not merit the space necessary to discuss them. Where does infection take place ? The conclusions of the Commission are based upon two facts : 1. Earth soiling is commonest in Porto Rico around the house, in the bushes, or in the dense shade of banana jilants which shelter so man}- huts. Exposed places are not sought for the accomplishment of this act but rather a secluded spot. The jibaro goes to "el monte," "the bushes." As these huts in the interior are very frequently on the edge, or in the midst of a coffee plantation, it thus comes about that the latter contains many true foci of infection. Not only this, but apart from earth soiling near the house, we ANEMIA IN PORTO RICO, 23 must consider the general pollution of the plantation by the laborer who is interrupted while at work by a desire to evacuate his bowels. 2. (a) In order to ripen to the larval stage the egg must be deposited under proper conditions of shade and moisture. In order that the life of the larva be preserved, drying must be avoided. The egg is far less resistant to this influence than the fully developed larva. (b) All decomposing vegetation, especially the detritus from the banana plant, forms a perfect medium for the protection of the young parasite. Our conclusion is that the c'ottee plantation of Porto Rico ofters the most perfect conditions for the development of the larva from the egg and for its preservation thereafter, Attention is invited to Table 10 of "Statistics," a summary of which is here inserted. SUMMARY OF TABLE 10. SHOWING TOTAL NUMBER PATIENTS CLASSIFIED ACCORDING TO THE USUAL LOCALITIES WHERE THEIR MAZAMORRA WAS CONTRACTED. Coffee plantations 11,660 Coffee plantations and surroundings of the home 1,099 Surroundings of the home only 461 Open country 977 Roads and paths 2,201 Rivers, streams and pools of water 165 Town streets 161 Stables and corrals 703 Tobacco plantations 19 Banana patches 161 Sweet potato patches 2 Surroundings of Public Schools 17 Sugar plantations 28 Not classified 420 Persons with ova of uncinaria in their stools, who deny having suffered from mazamorra 791 Total 18,865 The question, "AVhere do you generally get mazamorra?", was answered by 67 + ^, "In the finca." As we were working in the interior, tliis generally meant, "Finca de cafe" (coffee plantation). When one stated that he had received his infection from the surround- ings of his home, he generally meant its immediate proximity ; not from the shade of near-by bushes, but from the patio, or yard, shaded by the house or trees. All other localities mentioned always refer to damp places infected 24 ANEMIA IN PORTO RICO. by human feces ; spots wliich the sun fails to thoroughly dry. Mere sunlight does not usually kill the larvae ; however, it may retard their growth. Drying must be effected to destroy them. Infection in rivers and streams occurs from mud at the edges of such streams, not from the flowing water. Many washerwomen and water-carriers thus contract uncinariasis. Tobacco plantations and sugar plantations, are not such dangerous sources of infection, save in certain spots not open to the influence of continuous sunlight, or localities containing at all times a suflicient amount of water, such as ditches for irrigating purposes, simply because such spots are few and far l)etween, althougli they form ideal culture grounds for the larva. Thus, in all parts of the Island Avhere coffee is uot the chief product, as on the coast, infection is generally derived Irom the bushes in the vicinity of the home. The foregoing reflections are merely very general. While it is a fact that the Commission plainly sees that coffee plantations will always be the chief sources of mazamorra for the people of the interior, and we include the surroundings of the home as part of such plantation, in the vast majority of instances, as Table 10 shows, almost no place is exempt from contamination, because when night falls to screen his act, the countryman soils anywhere it may be convenient for him to do so. In the period of the annual rains, not only are the infective larvae widely scattered, but this is precisely the season when work goes on in the coffee plantation. Coflfee picking usually begins and ends at the time of torrential rains. Tliis is not generally a continuous rain Init an almost daily soaking of the earth. At such a time the plantations, in the shade of a heavy vegetation, never dry. Bare-footed workmen, men, women and children, swarm to secure the benefits of about the only regular employment they can count upon during the whole year. The little nick-nacks and innocent pleasures of the elaborate Spanish Christmas festival, not to speak of the supply of clothing necessary for the ensuing year, all depend upon reaping the small annual stipend allotted the pickers for this two or three months work. Thus the time of cofffee picking is for tens of thousands the only fixed revenue of the entire year and with all the eagerness with which they have flocked to our station for the cure of their terrible disease, they have temporarih-, to a great extent at least, abandoned their cure to seek this pittance that they may be enabled to spend a " Merry Christmas." Pitiful as it may be, it is a stern truth that thousands have thus gone to their death. Many times have we heard, in answer to the question, " Where did you get your mazamorra?" '• During last years cofl^ee picking." Here in a pouring rain they work, picking coffee and sowing disease and misery ANEMIA IN PORTO RICO. for the annual harvest of lives, as portrayed by the Island Health Reports in the usual 5,000 to 7,000 deaths a year from "Anemia." As generally the laboring man and his family in the country go bare- footed, in the rainy season mazamorra may be contracted almost anywhere, so that multiple int'ectious generally Itriiig al)Out uncinariasis, and any large increment of parasites may carry ott" the already half-sick " Jibaro." The Anemia of Porto Rico is a disease, it is an infectious disease, not an inherent condition, not an exhaustion of vital forces, not the natural end of mans existence here in Porto Rico. It cuts down man, woman and child of every age. It cripples industrial effort, limits mental expansion, weakens the body and depresses the spirit, until many laborers in a country where agriculture is the chief source of revenue, are enervated, despondent, without hope of betterment, and without the power to save themselves. Sometimes a man cannot earn enough to feed his family and he is driven to eat the crudest gifts of a bountiful Nature in the wild fruits of Porto Rico. We are now speaking of the great mass of the people, numerically considered, the very heart's blood of the country, a blood which, on an average, is below fifty percent of what it should and can be. Methods to be employed in a campaign against the Anemia of Porto Rico: After many and serious discussions the Commission has taken a final and ipletely and technically cured, as defined above, we find by a calculation based upon the data contained in Tables 9 and 13, that we have been able to reduce about 94.5^ the power of spread- ing the disease, the power of infecting the earth, in the 18,865 cases treated, ANEMIA IN PORTO RICO. 29 and that the 12,628 cases, reported as still under treatment, are only about 8.0'^ so dangerous as carriers of the worm and sources of infection, as they were before. These facts lead to most valuable conclusions: 1. In geueral terms, five doses of thvinol are sufficient to l)ractieally cure a patient suftering from uncinariasis. Exceptionally more than five may be needed and less than five may often be sufficient. 2. This number of doses generally reduces the danger ol a patient to the community, in regard to his poAver to infect the soil, about nineteen twentieths. o. In the treatment of outpatients, beta-naphthol is decidedly inferior to thymol. In the hospital, all cases who receive any anthelmintic are prepared for twenty-four hours before by a strict milk diet. Thus the vermifuge falls upon the parasites, unprotected by the mechanical covering offered by a full or partially filled intestine, and the results are not very different in one or the other drug ; but in prescribing anthelmintics to patients who are to take their medicine at home, in spite of our directions, these dietary instructions are not always obeyed. Under such circumstances, thymol is far more efficient than beta-naphthol in that, by the use of the former, the eggs disappear from the stools with fewer doses and the patient recovers more rapidly. PKESENT CONDITIONS IN PORTO RICO AVHICH AFFECT THE PROBLEM OF EXTERMINATING UNCINARIASIS. In consideration of the facts stated elsewhere in this report, we now understand how delicate a mission is tliat of the physician in Porto Rico, and how sacred a duty rests upon those who guide the affairs of the Island, to provide means for the fulfillment of that mission. People who of their own free will have cast to the winds the threadbare doctrine that counsels rich food when medicines are to be taken, and have covered great distances as many times as the physician requires them to renew their visits to the dispensary; who, realizing the significance of the explanation of their infirmity, almost universally place in practice the advice given them, without the need of the force of law; that peojile on whom the lack of knowledge of the elementary principles of hygiene weiglis so heavily in the presence of a disease which enervates and destroys them, merit the the kindest and gentlest consideration of those who map out the plan by which they may be imbued with the truths upon which sanitary laws are based, and the cure of their disease is effected. It is a people in whom a triumph for Progressive Medicine may be expected, We cannot look in any other than an optimistic light upon the sacrifices made by such a people, laborers who give up a days work so needful to secure the small and sole income with which they may meet their daily necessities. We cannot but admire the man who is willing to lose many times, that he may gain in the end his health or that of one of liis family. We must applaud the generous instinct that prompts him to spread far and wide his gratitude for what he has received and propagate the new ideas he has adopted, in order that his neighbors may prepare to defend themselves and imitate him in his self-imposed task of sanitary reform. When for so long, people have lived and died in an erroneous belief as has occurred with the current conceptions of the "Anemia" of Porto Rico, it is difficult to lead them back to a sound faith unless we bring to l)ear upon them the demonstration of truth enunciated clearly, kindly and firmly. In spite of liis earnest desire for health which prompts him to undergo any hardship to secure, the jibaro has a profound distrust for remedies heralded as cures for his anemia, and only a generous public spirit will make possible a general attendance at the dispensaries. ANEMIA IN PORTO RICO. 31 AVe point to the already loud cry for aid which proceeds from the an- emia-stricken jibaro, ever louder as time goes by, and do not believe that the cultured men and women of Porto Rico who realize the vital importance of the problem will hesitate to place within his reach the possibility of a cure which has over 20,000 times been demonstrated here in the Island. In order to reach our ideal, we beg your indulgence in permitting us to make clear certain problems in the work undei taken by the Insular Govern- ment, and by it fostered: The Medical Service to the Poor in Porto Rico. The Municipal physician, of course, is the one to whom all eyes are first turned. Some such reasoning as follows may be expected: This work, capable of being effected by physicians alone, is a problem for the Doctor. As the sick are generally the indigent poor, it is a question for the Municipal physician, the recognized guardian of public health, he Avho should cure the sick poor, and, in this instance, the one who should administer the specific remedy to the great mass of tlie district for whose health he is responsible. Upon him, then, there would fall all responsibilities of this nature not- withstanding that at present varied and numerous duties are required of him simply because he is a municipal functionary who practices in the poorest sections and fails to raise a protest on any occasion where the services of his noble calling are required. Such stoical patience, however, has its limit, and this limit is reached when, without a true understanding of the stupendous problem before us, this great burden, the extermination of the anemia of Porto Rico, is laid upon his shoulders; a double burden, of prevention and cure. The municipal physician today who is charged with the attendance upon the medical necessities of a district of ten thousand souls, by virtue of his accepting such a charge, is obliged to perform the duties of Sanitary Officer. Among these we may find obedience to the orders of the Superior Board of Health, such as regulations governing the inspection of meat, bread, milk and articles of food in general; inspection of beef and pork for killing, and of corrals, stables and pens ; the physical examination of butchers, bread- makers, cigar makers, etc., with the addition of the usual certificate needful in each case and the recording of all these facts in the proper official books. As Municipal physician he is required to treat the Insular Police posted in the town and to render service to all wounded in any official or private enterprise, such as road-building, etc. He not only has these duties but he is obliged to operate upon and treat such woundeil and make such autopsies as he may be ordered to do by proper authority, as well as to give expert testi- mony in any case which reaches the courts. A larger number of duties cannot be assigned him nor can greater 32 ANEMIA IN PORTO RICO. responsibilities be demanded of him, even if it is true that he receives the small compensation of his office, paid every three, six or twelve months. We have been compelled to portray the functionary who is first thought of when charitable medical work is needed, one whom some may consider, in ignorance of the above facts, the man of all men to combat a pandemic. The Commission, in its last report, estimated that 90% of the rural population was infected by the parasite causing this disease. If then it becomes necessary in a small municipality of eight or ten thousand souls to extinguish the scourge along the lines we suggest elsewhere, curing and teaching at one and the same time, treating the worm-carrier as well as the deformed and profoundly anemic invalid to whom public attention is attracted, it is not logical to consider that the present Municipal Physician of Porto Rico, in the midst of tlie pressing duties with which he is already loaded, can be the principal figure in the campaign. He can and will be an enthusiastic assistant in all that it is possible for him to do but he certainly cannot be a director of that work. When once the disease is thoroughly under control, when the throng of anemic sick is satisfied, when only here and there cases are seen, then he can deal with his local problem. It should not be understood from this that the Municipal physician is seeking to avoid the treatment of victims of uncinariaris as long as he is not relieved of some of his present duties. AVe know of many Municipal physicians who are attacking the disease today wherever they can reach it, and are ardent defenders of the Commission and teachers of its doctrines. The relation of the municipality to the work. Here we find that the sums appropriated by the town government for the annual care of sick and wounded would be small for the succor of such individuals in a healthy community. As the community is anything but healthy, as we have seen, and as the very poorest municipalities are, by grievous misfortune, the most heavily scourged by tliis epidemic and are, moreover, precisely the most numerous, we find that here the sick can not receive tlie aid they so much need, not because the municipality is careless of their wretchedness but because it simply has not sufficient funds. For this reason the Commission, in the last report referred to and in the present one reiterates the necessity for the assumption by the Insular Govern- ment of the responsibility for a labor which is really a social and economic problem, which intimately concerns the future of the Island. And as in the question before us the most important factor is the physician, only a medical organization, only a body of sanitarians and doctors, which the government may create and provide with adequate resources to enable them to make an efficient campaign of education and treatment, can deal with the disease that is menacing: the Island. RECOMMENDATIONS. Reasoning from what has been accomplished, we recommend that the present system of central station and substation be continued and further amplified so that the opportunity to receive specific treatment will be placed within reach of practically every anemic in Porto Rico. We advise that this work be directed by a Commission appointed by, and responsible to the Governor of Porto Rico, for its faithful and economic administration. This Commission should at all times be in touch with the Governor, rendering regular reports of its operations and consulting him before making any extraordinary or unusual expense or change of plans. The Commission would formulate the necessary regulations for the proper organization and administration of stations and substations, and should see that such regulations were carried out. It would investigate the conditions in regard to this tlisease in Porto Rico, select the locations for stations, substations, and dispensaries, make agreements with the various municipal authorities for their assistance, and establish the stations when these agreements are fulfilled. It would also continue the medical investiga- tion and study of the disease. We advise the establishment of seven central stations located at con- venient points so that each will dominate a large district and form for it the administrative center and distributing depot for medicines and other supplies; each central station to be in charge of a physician who would have direc- tion of all work in his district, responsible to the Commission for all opera- tions throughout all territory that may be confided to him, making monthly reports to the Commission. Tributary to the central station, there should be one or more substa- tions, and two or more dispensaries located in the smaller towns as the neces- sities of the district may require. The physicians in charge of these would be responsible to the director I of their central station, making weekly reports of their operations. We I estimate that ten substations and twenty dispensaries will be needed through- out the entire Island. ■ A central station should have a dispensary of, at least, four rooms, viz. — I examining room, dispensing room, storeroom, and office. It should be ! equipped with two microscopes with necessary accessories for examining I patients, utensils for preparing and dispensing medicines, and such furniture 34 ANEMIA IN PORTO RICO. as may be desired. In connection with this dispensary, there should be a hospital of, at least, twenty beds with equipment complete for the treatment of yery grave or special cases. It should be incumbent upon the city in which this station may be located, to provide the building and ordinary furniture, as chairs, tables, etc., for the dispensary, and building and equip- ment, as beds, bed clothing, cooking utensils, furniture, etc., for the hospital. The Commission should supply medicines, instruments, special equipment, and bear the expenses of personnel and maintenance of dispensary and hospital. The personnel of a central station should be: — Director $1,800 annually Assistant 1,000 Practicante 360 Scavenger 150 2 Nurses 120 Cook "2 Peon 60 13,562 The other expenses, exclusive of medicines, transportation, etc., are estimated as follows: — Installation and preservation S 120 annually Subsistence, with the ration @ 15 cents. 1,000 " Microscopes and clinical accessories 200 " Miscellaneous svipplies loO " 81,470 Each substation should have a dispensary on somewhat smaller scale than that of a central station, and hospital accommodation for ten beds, the town in which it may l)e located providing assistance in the same manner as in the case of a central station. The personnel of a substation should be ; — Physician $1,000 annually Practicante 300 Nurse 72 Scavenger and peon 72 Cook 60 Female nurse and laundress 60 $1,564 Estimating the other expenses at one half of those of the same class at central stations, the annual cost would be $735 per substation. The dispensaries would be on a still smaller scale than the substations, without hospital accommodations. The town should assist in the same proportion as at the larger stations. ANEMIA IN PORTO RICO. 35 The personnel of a dispensary should be ; — Physician $600 annually Practicante 180 " Peon 60 As the work at a dispensary would not be sufficient to occupy a physician's entire time nor justify compensation accordingly, as in the case at the larger stations, there would be no objection to the physician serving as Health Officer at the same time. Other expenses are estimated for a dispensary.; — Installation, etc $25 annually Microscope and supplies 60 " Miscellaneous 25 " $110 The general expenses may be classified and estimated as follows ; — Personnel of Commission $ 8,200 annually Medicines 10,000 Transportation 2,000 " Printing, Stationery, and Office supplies 1,000 " Travel 750 Laboratory 1,000 " Postage and Telegraphing 200 " Miscellaneous 616 " $22,766 We recommend that a sanitary inspector be attached to each central station, who would make periodical trips througli the district to advise, persuade, and explain to the people the necessity for the construction of latrines and the prevention of earth soiling. He would inform the director to what extent patients carried out the advice given them at the clinics, and report any cases of persistent and wilful neglect of these simple sanitary rules. He would also look up patients who failed to return, and assist very ill patients to go to tlie station when they could not do so of their own resources. For the seven inspectors the cost is estimated to be ; — Salaries $2,520 annually Horses 350 ' ' Care of horses .... 420 " $3,290 At one central station, the Commission would have its headquarters, general depot of supplies, and a small clinical laboratory. At that station 36 ANEMIA IN PORTO RICO. the Coniniif'!iii)ii would take direct charge of the work of that district in place of the director and assistant. A clerk should be employed to keep records and accounts, attend to correspondence and many small administrative details. To recapitulate, we estimate the cost for a full years work as outhned to be a.s follows ; One central station, substituting the Commission and clerk, for director and assistant $ 8.962 annually Six central stations 30,192 Ten substations 22,990 " Twenty dispensaries 19,000 Medicines 10,000 Transportation 2,000 Printing, Stationerj-, and Office supplies 1,000 Sanitary Inspectors 3,290 Laboratory 1,000 Travel 750 " Postage and Telegraphing. ... 200 Miscellaneous 616 $100,000 As already stated, this amount is estimated as if each station were or- ganized and working during the entire year. As a matter of fact, only the eleven stations now in operation would draw upon these funds from the be- ginning. First these would have to be reorganized in accordance with the plan outlined, then new stations organized and put into operation as rapidly as possible. Some delay would inevitably occur before all arrangements could be made with the municipalities where stations may be located, and they be able to fulfill their part. Allowing that this delay would cause a reduction of 20^ in the entire year's expenses, the annual estimate is thus reduced to $80,000. We recognize that this sum is a large advance over the present appro- priation of §15,000, of which nearly §11,000 was expended during six months work. Here it must be taken into consideration that two of the members of the present Commission are officers of the United States and received no mone- tary recompense whatever from the Insular Government. Also that they were supplied with the greater portion of the laboratory equipment by their Services without expense to the appropriation. This assistance will be lack- ing in the future. Again attention is called to the fact that the substations at Barros, San Sebastian, and Moca have cost the Commission only the expense of the medi- cines and transportation of the same. The physicians at these places so de- sired to take part in this labor, and, dissatisfied with the results obtained in the treatment of this "anemia" by iron, tonics, etc., so desired to extend the bene- fits of scientific treatment to the anemics of their localities, that they volun- ANEMIA IN PORTO RICO. 37 teered their services to take charge of these stations without recompense from the Commission. Even to those physicians who were remunerated, the amounts paid were miserably inadequate for the services rendered. This is a sacrifice of time and labor which Porto Rico has no right nor need to de- mand, but should reasonably recompense such valuable services. "The la- borer is worthy of liis hire". While the operations of the present Commission have been carried out on a really large scale, yet in proportion to the conditions confronting us it has been comparatively small. By reference to the financial statement, it may be seen how economically it has been done. In 1903, a systematic examination of the miners of Westphalia showed that 17,161 of 188,730 miners were infected by the parasite causing this disease. In certain mines, during nine months work, the infection was reduced 73*^. In addition to the large sums contributed by the miners and mine owners, the German Government spent 3,000,000 marks ($720,000). We have treated 18,865 cases in six months, at a cost of $10,908.77, and have reduced the infection 94^ among those treated. The success attending our eftbrts convince us that what this Commission and its co-workers have accomplished on a comparatively small scale, can be done on a sufficiently large scale to meet the urgent need of Porto Rico. It is simply a question of funds and proper administration by those who have knowledge and experience in this particular field. We do not believe that $80,000 will meet fully the condition that it is proposed to attack, but it is probably sufficient to cover what can be done during the coming year. In following years, new stations should be established in places that may be but remotely touched by the present estimated work, or in case some stations should have accomplished their end, they could be moved to another place yet heavily infected, leaving only a dispensary to care for those few who may not have applied for treatment, and those few who become reinfected. During 1904, this Commission demonstrated beyond a doubt the charac- ter and curability of this "anemia", and during 1905, proved the feasibility, from both curative and preventive points of view, of the measures advocated. With this conviction of certain success, did we recommend any less, we would fail in the most important phase of our duty. Slower yet more deadly than yellow fever, uncinariasis caused more deaths in 1905 in Porto Rico than yellow fever did throughout the entire world, notwithstanding the unusual prevalence of the latter disease during the year, yet cost is not considered in the presence of yellow fever. No doubt the sum herein advised may seem startling to some because they have not been accustomed to regard this work as a regular go vernmental expenditure. Large amounts for asylums, police, jails, quarantine, and t he vast machinery of the law are expenses to which every one is familiar, and 38 ANEMIA IN PORTO RICO. they are expected as a matter of course. During the fiscal year 1904-1905, $457,320.54 was expended for police and jails; the administration of justice requiring $262,250.36; the Insane Asylum, $34,420,73 to care for such unfortunates; for the Leper Asylum, $7,079.95 to care for, and protect others from, its inmates; for the Boys Charity School, $32,317.47; the Girls Charity School, $18,064.63. We do not wish to belittle the necessity for such expenditures nor to criticise them, as we recognize that such are necessary if a government fulfill its primary duty, the preservation of the lives and health of its citizens. We do wish to emphasize by comparison with accepted expeilditures, that the amount that we advise is small in the face of such vast need and in relation to the great benefits to be received not only in saving of life and suffering, but a financial economy of thousands of dollars to laborer, employer, and the Island generally. We most earnestly advise and urge that the campaign against uncin- ariasis in Porto Rico be pushed with utmost energy. It would be economy of life, time and money to expend from the first the greatest amount possible to obtain from every resource. The greater the amount ex- pended now, means the sooner and cheaper the results will be accomplished. The greater number treated, the less number to spread infection and a result- ing less number re-infected each year. In all discussions about this disease, j much attention has been paid to the prevention of it. We have shown that ' the wholesale treatment of the infected, thus removing numerous foci of infection, is the most thorough and practical method of prevention. Our experience coincides with that of the German workers in this same question. It is a simple arithmetical computation to show that small appropriations will simply prolong, almost indefinitely, the conditions now existing, and the money expended would be a constant drain on the Insular treasury, amount- ing to much more in the end. The stations once established, the per capita cost of treatment becomes proportionately less as the number of patients increases, because the actual cost of medicines (including transportation of same) is but a few cents, and, while tliis cost would be increased somewhat, other expenses would not be materially affected. Thus a large number of persons can be treated almost as cheaply as a much smaller number. We estimate that about 800,000 of Porto Rico's 1,000,000 inhabitants are infected with the parasite causing this disease, and that the infection is increasing, i.e., those yet unaffected are becoming infected, and those already infected are becoming more heavily so. By the expenditure of the amount advised, we estimate that over 100,000 persons can be treated. Until large numbers are treated, thus destroying numerous sources of infection, the disease will continue to increase or hold its ANEMIA IN PORTO RICO. 39 own. Sooner or later, large sums must be spent and until then, the loss of life, time and money wliich could have been saved will have been sacrificed for nothing. The problem of attacking uncinariasis is now confronting almost every country of tropical and subtropical climes, not to speak of the many infected mines of more northern countries. Porto Rico has taken front rank in the solution of this problem by the vigorous campaign which has been inaugu- rated. Its work has become known and watched by the entire world. To allow it to end at this point or even to fail in fulfilling, to the limit of its resources, its plain, imperative duty in the matter, would be to lose a great part of what has been accomplished at the cost of much labor and money. EEPORTS FROM SUBSTATIONS. SUBSTATION IN LARES. Lares, December 31, 1905. The large number of auemics who in a relatively short time came to this Station, and the fact that I was alone, discharging the duties of Health Officer and occupied with the just demands of my private practice, have confined the work, to my regret, to the periodic microscopic examination of the feces of each individual, noting such salient points in peculiar cases as might be of interest. At the beginning, acute forms of uncinariasis were seen in persons, until recently well and robust, without the well-known and characteristic symptoms of the disease. They were patients who suddenly became drop- sical, with dyspnea, bloated features, almost complete anuria, and in whose feces it was generally difficult to find eggs of uncinaria. On applying the anthelmintic treatment, these individuals were cured, many of them rapidly, modifying the treatment in intervals between the administration of the vermifuge according to the necessities of the case. Some of them died the day after the drug was given, others later; still others ceased to returu that their cure be completed. Upon the clinical histories of the latter no definite result has been noted but I have reliable information of their apparent cure inasmuch as they are devoting themselves to their usual hard labor. This brusque invasion of the disease appears with an epidemic char- acter ill many barrios daring the months of May and August, and is denom- minated by the country people (perhaps by antithesis), •' La hermosura", "the beauty." The first 2,000 of my cases were treated by thymol. The administration of this drug, the dose of which was graduated according to the age of the patient and never exceeding four grams in a single day among adults pre- sented no unpleasant features. I only once observed any ill effects, an in- tense inflammation of the digestive apparatus in a young woman, who, the same day after the diagnosis was made of her uncinariasis and following the purge taken in the afternoon of that day, took all of the capsules of thymol at once and proceeded to pass the night somewhat too merrily with friends. The following day, she had dysphagia, intense gastro-enteralgia, vomiting, som- nolence and great weakness. This condition slowly passed away in the ANEMIA IN PORTO RICO. 41 course of eight days and she recovered entirely, not returning, however, to this station. I gave reduced doses of thymol to pregnant anemics without producing any unpleasant results, the woman giving l)irth later at the normal time of labor. In view of this, I gave the full dose to such patients as presented themselves for treatment thereafter, and with a like result. These facts permit me to say that, in the doses I have employed, thymol is a powerful, efficient and harmless anthelmintic. In many cases eggs of uncinaria were not found after the first dose. Like results in regard to anthelmintic power and freedom from danger were secured with beta-naphthol. My observations on beta-naphthol, how- ever, can not be nearly so satisfactory as those on thymol because I have not yet had time to complete them for the purposes of comparison. Many of those who are taking beta-naphthol have taken but one dose so far, although they began in the midiUe of October or November. I believe, however, that it is an efficient, harmless, and excellent anthelmintic. In the short period of twenty weeks, there have been admitted to treatment 4,001 anemics proceeding from this municipality or the outskirts of neighboring ones, Utuado, Adjuntas, San Sebastian, Camay, Hatillo, Las Marias and Arecibo. The periodical attendance upon this Station, exacted of the patients as a means of obtaining a rapid and positive cure, resulted in 12,273 visits to my clinic, an average of 3 visits to each patient, at each of which they received anthelmintic treatment. I have not included in this number the visit at which they were discharged as cured. The coffee picking season has made a considerable diminution in the attendance, and for this reason the number of anemics that has come from barrios devoted to coffee culture and at the same time far from the town, is relatively much less proportionally than that of the others of this municipality. Bartolo and Rio Prieto, mountain barrios, bordering on the municipality of Las Marias and Yauco, are large and well populated, with many anemics, and still they fall below the others in nundjer of patients. The great distance from the town contributes largely to make their journey difficult. For tliis reason I am thinking of carrying a station into those barrios in order to facilitate the cure of their sick. Of the 4,001 anemics already noted as having been treated at tliis Station up to the thirtieth of November, 3,457 came from Lares and 544 belonged to other municipalities, the barrio of Angeles, Utuado, giving the greatest number. A comparison of the sex of my patients shows the males to be more numerous. Perhaps their occupation, rendering the male more exposed to infection, has its influence. 42 ANEMIA IN PORTO RICO. Notwithstanding that at first women did not come so frequently as men to the Station because they did not like to bring their feces for examination, it is a fact that they gradually became convinced of the value and success of the drug and are now attending regularly upon the clinic. Sex of patients: Males 2,216 Females 1,785 I performed two autopsies (upon numbers 3,004 and 3,400), sending to the Central Station their clinical histories and specimens of organs and tissues for microscopic study. Dr. Francisco Sein. SUBSTATION IN GUAYAMA. Report submitted to the Porto Rico Anemia Commission. Covering the period August 1 — November 30, 1905. The Members of the Commission, Sirs : In April, 1904, upon the inauguration of the work of the Porto Rico Anemia Commission in Bayamon, I made a visit to that town with the object of personally studying the results of the treatment of uncinariasis by thymol. Although I had instituted this treatment in a few cases, they were under my care only a short time and I had not been able to arrive at a definite conclusion as to the exact effects of this drug. Moreover, I had used preparations of iron at the same time and my patients often failed to continue the anthelmintic. There I was able to even more thoroughly appreciate the power of this drug over the little nematode which undoubtedly has come to be the greatest scourge that can fall upon our eountr}' class and which constitutes a true medico-social problem that, thanks to the Commission and to medical men of this Island who are laboring constantly to meet the danger, seems to be on the road to solution. In July of tliis year, on invitation of the Commission, I went to Aibonito where I spent several days with others in assisting them in the labor they had so well begun. There I became advised of the manner in which the work was to be carried on during the year and on the 1st of August I opened a substation of the Commission in this city, aided by my Surgical Assistant, Francisco Llacer. From that time up to the 30th of November, seven hundred and forty ANEMIA IN PORTO RICO. 43 six anemics have been treated, many of whom have been cured ; very few have died, others have failed to return, and the majority are still under treatment. Of the two vermifuges, thymol and beta-naphthol, undoubtedly the preference should be given the former because its effect is more rapid and it is more efficient. I have had no experience with its poisonous effects because I had no cases in which these results followed its administration. This does not mean, however, tliat we are ignorant of such phenomena nor that we deny its toxic properties, when used with liquids which dissolve it and which are sufficient in quantity to cause such effects, in wliich case even death may follow. As far as my experience goes, however, I am able to say that l)otli drugs are easy to manage and are relatively innocuous, it being merely necessary to counsel the patient against the dangers resulting from the concomitant use of oil or alcohol. This station has met with some obstacles among which some have been easily overcome. One has been serious and has cost me much hard work; namely, the unwillingness of the country people in this region to attend the dispensary clinic. The entire matter seems to have depended upon the resistance offered by the people to bringing the feces for examination but I have the satisfaction of knowing that I have done all in my power and of having sown the seed which will surely give good fruit in the future. The treatment of uncinariasis does not only consist in the administration of the drug ; it should at the same time be reenforced by an education in public health. I affirm that fully seventy five per cent of the persons that have been treated in this station have built their latrines and I am told, and this comes from sources wliich I believe to be true, that their example is being followed by the others who have not attended the clinic, it being easier to convince them of the necessity of thus protecting themselves than to induce them to bring specimens of their feces to the station. Under this city runs an irrigating canal, probably constructed over fifty years ago, which the people living in its vicinity have used to carry off the sewage from their latrines and water closets. The last Health Officer, my predecessor, submitted to the Superior Board of Health a plan by which this canal was made a sewer and up to the month of October some additional water closets were made to communicate with it and some reforms made in the old ones that existed and which failed to comply with the plumbing regulations. The attendance upon my clinic of some servants employed in houses where such water closets existed brought me to see the danger to which barefooted workmen in the sugar plantations watered by this canal were exposed. Reflecting upon the matter, and sure that they would view it in the same light, I asked, of my own accord, an expression of opinion 44 ANEMIA IN PORTO RICO. from the Anemia Commission. I carried the matter to the Honorable Supervisor of Heahh on the 23r(l of October and upon the first of December the Board of Heahh agreed to sustain nie in my position upon the subject. It wouhl be a pity and an economic error if so humanitarian a work as is the campaign against this disease, a work so satisfactorily begun by the Anemia Commission with so little funds, should be paralyzed for the coming year. The people of Porto Rico has before it the problem of highest importance since the discovery of the Island to the present date and the Legislature should solve it. Neither five nor ten nor fifteen thousand dollars are sufficient for the extinction of this terrible plague. The situation in Porto Rico is much more difficult to handle than the same one wliich has appeared in the mines of Europe. There the parasitic infection is confined to the mining regions, the number of those attacked by the worm has been much less, and the disease is much easier to prevent; nevertheless, the work that is being consummated in Porto Rico excells that of Europe, above all in point of economy. The foundation of a League against Uncinariasis by my friend Dr. Gonzalez Martinez of Mayagiiez, has come to round out the work of the stations and is an organization which has interested all classes of society. It is necessary to continue the Stations if Porto Ricans desire to eradi- cate the disease in a brief time; and this time is not measured by months but by years. I believe that the moment has come for the work to pass from the stage of clinical laboratory investigation, a stage through which it had to pass, to a greater field, purely clinical, in which all physicians in every town may take part, even without the instruments necessary to make such a clinical labor complete. As, however, laboratories should still be kept up, the Com- mission should continue to direct the campaign and the number of its mem- bers should be increased to five, at least. I would suggest the following plan: Five Medical Commissioners to continue the work begun by the present body to cure and extinguish the epidemic. Each one of these would be at the heatl of a Central Station with a sufficiently large Corps of Assistants to complete the work in liis tlistrict in which there would be opened a station in each town. These Commissioners should meet at least once everv four months in order that there might be unity of opinion in the administration of the work and they should be invested with all the rights and responsibili- ties of a Commission which directs so large an enterprise. In the work of my station in tliis district I have been efficiently assisted by the Mayor of this city. Doctor Enrique Gonzalez Tattgreen, who not only provided an appropriate place for a dispensary, but who placed at my disposition two employes for the purpose of arousing the interest of the ANEMIA IN PORTO RICO. 45 people in the country districts anil for ailmonishment concerning the con- struction of latrines. I also wish to acknowledge the assistance of Don Mo- desto Bird Leon, President of the City Council, who supported in the Council the providing of additional beds for a large number of anemics, and to Mr. George B. Benedict, Pastor of the Methodist Episcopal Church, who, in addi- tion to his religious teachings, has sought to advance the campaign against the disease. Finally I desire to thank all those, including my colleagues who form the Porto Rico Anemia Commission, with whom I have frequently com- municated, who have aided me by their counsel and experience to solve the difficulties concerning which I have consulted them. Respectfully, Dr. Raphael Cesteros, Director of the Substation of Gnayama. Guayama, P. R., 29th of December, 1905. SUBSTATION IN BARRANQUITAS. One thousand, four hundred and twenty-tive patients have applied to this station for treatment and all show their satisfaction in the results obtained. Although a short period only has elapsed since this station was opened (scarcely five months), I have been able to realize the efficacy of anthelmintic treatment, it being only necessary for me to recall those marvellous cases in which the patient has been actually snatched from the jaws of death. Nevertheless, it does not seem to me to be sufficient to simply combat the morbidity and mortality caused by the disease. It is needful to surround our country classes with hygienic reforms in order to prevent the further propagation of the disease. In this labor, and it is indeed an arduous one, the medical men of the country, assisted by the "League against Uncinariasis," should busy themselves and in this way we can hope to reach that point where it may be said that we have a people more fitted for work and for the betterment of their country. Beta-naphthol and Thymol: Here we have two weapons with which to fight the disease. Which is to be preferred? As far as the results at my station go, I should say that I prefer thymol for I have better and more rapid results from its use. I have had cases treated by repeated doses of two grams of beta-naphthol in which I became obliged to give up the further use of this drug and finish with thymol, thus obtaining the desired result, a cure. For this reason permit me to recommend 46 ANEMIA IN PORTO RICO. to my colleagues the use of thymol in preference to beta-naphthol, especially in serious cases. How shall an efficient prophylaxis be effectuated ? Can the physician in Porto Rico carry out such a campaign to a successful issue? Can the municipalities be charged with this responsibility ? In spite of the multiple duties of the physician in Puerto Rico and the scarcity of funds for hospitals, dispensaries, etc., there is no excuse for his not taking an active part in the prevention of uncinariasis. As a people can be educated for political, social and religious betterment, it can also be taught the i)rinciples of hygiene. The mission of the Physician should not limit itself to the treatment of the sick from uncinariasis; he should extend his sphere of action to the family and neighbors of the patient in the form of prophylaxis. He should carry out an offensive and not a defensive warfare, not sit for hours in his office calmly awaiting the appearance of one patient today and another tomorrow. It is necessary to throw aside professional materialism and to sacrifice something for humanity. We do not need conferences, assemblies, and grand oratory in those centers in which the countryman does not gather and in which all that is done is to affect a knowledge of medical science larded with eloquence. To the open country, to the barrios, to the hut of the unfortunate countryman we must go, and witli practical advice which will acquaint them of the danger of careless living ! The part to be taken by the municipalities is of highest importance, for these corporations can and are in obligation to better the conditions of life of the poor. In order to secure resources to this end the Government should cede them 1^ of the results of the direct tax which measure would assure them a 15^ increase of what they actually have, establisliing with this difference an annual quota, just as in the case of the School Tax, for the ends specified above. The establishment of villages in the barrios is urged in order tliat the people can be under the direct inspection of him who is supposed to watch over tlie sanitation of the country districts. In concluding I will say something concerning the treatment by iron: Witli few exceptions I have given iron to many patients but I have seen the small necessity for this medicament, obtaining by the expulsion of the para- sites the rapid disappearance of the symptoms of uncinaria and the increase of the liemoglobin of the blood. Dr. Felipe F. Vizcarrondo Director of the Substation of Barranquitas. ANEMIA IN PORTO RICO. 47 SUBSTATION IN BARROS. Gentlemen of the Porto Rico Anemia Commission: I have the honor of transmitting, as requested, a brief report on the work accompHshed. in the campaign against uncinariasis in this municipality. This station opened the first of August under my direction and from that date to the present I have been supphed by the Central Station in Aibo- nito with all that was necessary to combat tlie disease. It is certainly a fact that the ankylostoma duodenale, in its species uncinaria, is a parasite of our country people, causing in them the profound anemia from which they suffer more than tlieir poor and insufficient food. It is no less positive that almost all of them acquire mazamorra. Only four of 1,255 cases denied having suffered from it. Its cause is found in the custom of going barefooted in places where those infected have sown the larva in the earth through evacuating their bowels in such spots. The larvte are found almost anywhere for the reason that, with very few exceptions, there is absence of a latrine in the houses and that the bushes are utilized for this purpose. These evacuations, carrying the eggs of the parasites, develop into embryoes which produce the mazamorra or are carried to the drinking water. I desire to manifest to you my satisfaction at the results of the treat- ment of my 1,255 patients, for I have only lost five and these cases were very intense or complicated with other affections. I have, apart from these, seventy more in treatment which have not been classified for lack of time and wliich will be included later. To the Mayor of tliis municipality, Don Roberto Vives, I am indebted for valuable assistance rendered. He had all medicines transported here and ordered the construction of latrines throughout the district. This order is being enforced by the police and I can assure you that at least fifty per cent of the houses have them. Sincerely yours, Gkegorio Santo Domingo Gonzalez. Health Officer. SUBSTATION IN COAMO He who subscribes this report. Physician charged with the duty of prosecuting the work of treating Anemia (Uncinariasis) at the Substation in Coamo, reports : That from the first of August last, on which day the work of this station was begun, to the thirtieth of November last, 1,048 patients have been treated for uncinariasis. Of these 452 have been discharged cured. 48 ANEMIA IN PORTO RICO. Only two (lied; one, an old man that had been suffering for some time from a compensated valvular lesion of the heart; the other, a very young child really a victim of intense anemia, dying, however, with symptoms of meningo-encephalitis. Tiie majority of my cases were treated by beta-naphthol. I have used thymol in more than three hundred cases and I have never had a case of poisoning, for when properly informed as to how the drug should be taken our countrv people carry out with great care all the details as ordered. This is the reason for general success in their treatment. My personal experience is that beta-naphthol is the drug to be preferred for the lighter class of cases but I have observed in those cases of great intensity, which are always accompanied by renal lesions of greater or less severity, that the continued use of naphthol aggravates the condition of the kidney, even to produce intense albuminaria, as occurred in one of my cases. Thymol is to my mind a more pow^erful anthelmintic than beta- naphthol. I believe that the latter is the drug with which we should begin in the treatment of very severe cases, and that when the treatment threatens to be prolonged by beta-naphtol, a few doses of thymol should be given to thus enable us to expel all the parasites in a shorter time and with fewer doses. Dr. L. Igaravidez Landron. SUBSTATION IN UTUADO. Utuado, Porto Rico. Guided by the excellent work accomplished here last year by my col- leagues who today form " The Porto Rico Anemia Commission" and finding, as a result of their labors, a perfect basis on which to continue it, I devoted myself to tliis beneficent campaign without being deterred by obstacles nor by the difiiculty of the work. In this manner I am able to see the reality from a point of vantage over others. To discuss scientifically the question of whether or not the uncinaria is the cause of the innumerable sick here, is very natural, inasmuch as points of such capital importance merit something more than a mere exchange of views. But to carry the matter to a debate without considering the views which have been echoing about us for seventy eight years and without taking cognizance of the very recent and conclusive facts demonstrated here, would be to refuse to admit the evidence and to openly oppose the march of Science when our position should be frank and disinterested. In the relatively short period during which I have been discharging the duties of Director of this Sub-Station of Utuado, I have again been able ANEMIA IN PORTt) KICO. 49 to realize the efficacy of this anthehiiintic and other appropriate treatment in all those in whom a previous examination has revealed the jiresence of the worm. I have not failed in one case and have secured in all an immediate relief from their complex clinical picture. There have been hundreds, who, cured by the Commission in their labors here in 1904, were examined by me this year and found free from the disease. There were also many who stated that although they had not recovered at the date at which that Commission ceased its labors, either presented no eggs of uncinaria in their stools this year or, saved from the grave anemia from which they formerly suffered, still showed a heav}' infection. These facts speak for themselves of the enormous value of the plan put in practice and serves as an efficient demonstration that anemia in Porto Rico can be exterminated and that for this end we only need the enthusiasm of men who have in mind their studies and the interests of their country. Just as it is true that it is necessary, as we all know, to nourish our patient well at the same time that we employ medicine, it is also true that an efficient prophylaxis of the disease must be carried into effect. Never- theless, these two necessities must not be converted into reasons for denying that the cause of this anemia, this tropical chlorosis, is that variety of Ankylo- stoma duodenale, Uncinaria americana of Stiles. Bad food weakens the resistance of the organism and a debilitated subject is exposed to the gravest forms of disease. Neglect of preventive measures opens the wa\' for the invasion of parasites in a weakened economy. But these two facts must be counted merely as predisposing factors to the disease. It is not necessary to further discuss an acknowledged fact and lose time in arguments. It is of prime importance that we unite and support the initiators of the work, dedicating to our country poor, and even to those of a better station in life, all of our time possible, with the end that we may teach them the facts. Not only this but we should publish the statistics of the work, a basis for knowledge more certain and patent than all others, and a proof of the excellent fruit of a labor accomplished, thanks to those wlu) form the Government. These very ones will then be amply convinced of the fact that no public money has been better spent. Those of us who devote ourselves to research and who are not willing to neglect the opportunity of amplifying the studies begun in the lialls of our universities, ought to pay particular attention to the pathology of the disease in question. We should pursue the studies of Grenet and Mayott, and especially as the facts derived from this important branch of the Science of Medicine are scarce, we should seek to contribute to them, making clear some doubtful points. Let us continue, then, the work begun without hesitating one moment. 50 ANEMIA IN POKTU RICO. Ix't us RMiuest the aid of the Government in such vital matter that we may he able to thus write one of the most notable pages in the present history of tin's Islanii of I'orto Rieo. Dr. Miguel Roses. NOTK 15Y THE COMMISSION. Tlie translation of tlieso reports has l)een a very free one but the sense has not been altered. The dillerenee between the JOnglish and Spanish eonstrnction is so great that we have thought this measure i)roper in justice to both languages. ANExMIA IX PORTO RIC'O. 51 FINANCIAL STATEMENT. Salaries S 4,426.90 Medicines, 2,086.24 Actual cost of medicines, 8 2,086.24 Transportation of same, 897.96 2,484.20 Average cost per patient lo.ll ^-cents. Subsistence, 9,994 rations of patients and employees at 14.31-rcents, 1.480.51 Travel, Members of the Commission. Directors of substa- tions, etc 667.06 Transportation 646.00 Medicines, ._ $ 897.96 Hospital from Utuado to Aibonito. and materials, 198.57 Laboratory supplies, 4.85 Clinic supplies, 8.66 Miscellaneous, 45.96 646.00 Installation, Repairs, House for employees, etc., 520.23 Piinting, Stationery, and Office supplies, 807. 14 Hire of carriage (including driver, etc. ) for service between Aibonito and hospital, 267.00 Laboratory, 226.91 Installation, etc 8 80. 68 Supplies and apparatus, 1 96. 28 Transportation, 4.85 281.76 Instruments for clinic, 141.52 Microscopes, § 91.00 Slides, covers, and miscellaneous, 50.52 Transportation, 3.66 145.18 Postage ct Telegraphing, 44.84 Miscellaneous, 36.92 8 10,808.77 Appropriated by Municipality of Aibonito, expended for labor of installation, 100.00 Total cost of six month's work, $ 10,908.77 Average cost per patient 5 7. 8 2 -f cents. INFORME PRELIMINAR DE LA riAMTCI ISION PARA LA WIM DE LA ANEil EN PUERTO RICO. Nombrada de acuerdo con una ley de la Asamblea Legislativa Aprobada en Marzo 8, de 1905, para continuar el trabajo de la Comision para el Estiulio y Tratamiento de la Anemia en Puerto Rico. Respetnosamente presentado al HONORABLE BEEKMAN WmiHROP, Gobernador de Puerto Rico. ENERO 1 BE 1906. BUREAU OF PRINTING AND SUPPLIES. SAN JUAN, P. R. ERRATAS. Pdgina 30. pArrafo 3. linea 5; donde dice "90.17^" debe ser "92.39^' PAglna 30, pdrrafo 3, linea 7; donde dice "95.28»f" debe ser "97.555^' Pdgina 30, pdrrafo 3, linea 9; donde dice "96.575^" debe ser "99.06^' CAETA DE TRASMISION. Aibonito, P. R., Enero 1 de 1906. Senor: — Tenevios el honor de enviar a V. H. el informe preliminar de las opera- ciones de esta Comision, desde el 1 de Junio, al 30 de Noviembre de 1905. En el hemos expresado, con el menor tecnicismo posible, los resiiltados obtenidos, nnestras observaciones y recomendaciones concernientes a la Unci- nariasis en Puerto Rico. Aunqiie este informe incluye solamente nuestras operaciones hasta el SO de Noviembre, el trabajo de todas las Estaciones contimia sin interr^ipcion, y nosotros esperanios que nos sea dado sostenerlas, con el credito votado, hasta el 1 de Febrero de 1906. Son los propositos de esta Comision p)ublicar, en no lejana fecha, vn informe incis completo que inchiya los resultados de ciertos estudios de orden puramente cientifico; observaciones pertinentes a nnestra labor en el Dispen- sario, en el Hospital, y en el Laboratorio. Respetuosamente, Pedro Gutierrez Igaravidez, 31. D. W. W. King, 31 D. Passed Assistant Surgeon, if. S. Public Health and Marine Hospital Service. Bailey K. Ashford, 31. D. Captain, Assistant Surgeon, U. S. Army. Honorable Beekman Winthrop, Gobernador de Puerto Rico. LEY Disponiendose que continue el trabajo de la Comision para la supresion de la Anemia en Puerto Rico, y asignando un credito con este objeto. Decretese por la Asaniblea Legislativa de Puerto Rico : Articulo 1. — La suma de quince mil dollars, 6 parte de la misma que fuere necesaria, queda por la presente asignada de cualesquiera fondos en Tesoreria no destinados a otras atenciones, para continuar los trabajos encaminados a suprimir la enfermedad conocida en Puerto Rico con el nombre de "uncinariasis." Articulo 2. — Diclia asignacion se invertira, bajo la direccion del Gobernador de Puerto Rico, en los gastos indispensables para llevar a cabo la obra, establecer hospitales, comprar medicinas y materiales y el empleo de medicos, enfermeros y demits personal subalterno que fueren necesarios. Articulo 3. — Queda por la presente autorizado el Gobernador, si lo estimare conveniente, para utilizar como hospital, cualquiera 6 ambos cuarteles, de los dos construidos respectivameute en Humacao y Jayuya para los presidiarios destinados a trabajos en los caminos. Articulo 4. — Esta Ley empezara li regir desde la feclia de su aprobacion. Aprobada en Marzo 8, 1905. BREYE RESENA DE LAS OPERACIONES DE LA COMISION. Esta Comision, que fue nonibrada en Marzo de 1904, para est udiar la enfermedad conocida con el nombre de Anemia en Puerto Rico, estudio y trato dicha enfermedad, desde aquella fecha hasta el mes de Agosto del mismo aiio, en 5,500 personas, demostrando que la Uncinaria duodenalis era responsable del mayor numero de anemicos existentes en la Isla, la posibi- lidad de su curacion a un costo sumamente economico y recomendando, al mismo tiempo, las medidas que debieran tomarse para evitar su difusion. El resultado de estas investigaciones, publicado bajo el titulo de "Informe de la Comision para el estudio y tratamiento de la Anemia en Puerto Rico" fechado el 1 de Diciembre ele 1904 fue de tal importancia, que la Asamblea Legislativa, en su sesion siguiente, voto la suma de $15,000 para la conti- nuacion de los trabajos, y el Gobernador de Puerto Rico reeligio al efecto, con fecha 1 de Mayo, li los miembros de la primera Comision, quienes cons- tituyeron la Junta conocida con el nombre "Comision de Anemia de Puerto Rico." Como aquella Comision habia propuesto en su memoria, dos metodos para atacar el mal, la mision de la nueva Junta era llevar a la practica sus dos metodos aconsejados. Se hicieron, con este proposito, los calculos para una extensa campana y las ordenes para obtener los medicamentos y efectos necesarios en cantidad bastante, fueron dadas a diferentes casas de los Estados Unidos. Estos pedidos, en gran cantidad, nos dieron la ventaja de la rebaja en el precio. Mientras tanto, la Comision preparaba sus planes para establecer una Estacion Central y algunas Sub-estaciones, no pudiendo determinar el numero de estas, hasta tanto que dieran principio nuestras operaciones y supieramos cuanto podiamos dedicar a cada una de acuerdo con los recursos asignados. Nos preocupamos en primer termino, por darle situacion a nuestro Consultorio con Hospital anexo, y Oficina a la vez de la Comision, discu" tiendo la conveniencia de llevarlo a un pueblo del interior de la Isla donde la enfermedad prevaleciera y ningiin trabajo de la indole del nuestro se hubiera hecho; donde su posicion dominara un extenso territorio, al que llevariamos Sub-estaciones; y donde hubiera facilidades de comunicacion y las autoridades municipales le prestaran su decidido apoyo moral. Aibo- nito, fue considerado por nosotros como una localidad que reunia estas condiciones. Hicimos una visita a ella con el fin de elegir local para el Consultorio y sitio para nuestro Campamento-Hospital, fijandonos, como ANEMIA KN PUERTO RICO. lo mas conveniente por su situacion, en una casilla de Peon Caminero sita a poca (listancia del ])ueblo y al Norte de el. El estado de esta casilla requeria reparaciones de consideracion, y no era, ademas, lo bastante eapaz para el Consultorio, siendo de necesidad anadirle una habitacion. Para contribuir a la ejecucion de esta obra y d las reparaciones del local, ofrecio generosamente el Municipio la cantidad de §100 y "The Porto Rican Leaf Tobacco Company" por voz de sus representantes los Senores Don Rafael Maria Gonzalez y Don Leon Dubois, prometio ceder el terreno necesario, d espaldas de la casilla, para establecer nuestro Campamento-Hospital. Aceptados estos ofrecimientos la Comision se traslado a Aibonito, en los primeros dias de Mayo, para dirigir el ensanche y reparaciones del edificio, cuyas obras no quedaron terminadas hasta la segunda semana del mes de Junio; aunque estuvieron lo suficientemente adelantadas para poder abrir el Dispensario el 1 de Junio. Las tiendas de campaiia y demas efectos del Hospital, que habian que- dado en Utuado al terminar el trabajo el afio anterior, fueron transportados d Aibonito y situadas aquellas en el campo que nos fu6 cedido, siguiendo una linea curva marcada por los puntos nnis elevados del terreno. En un extremo de esa linea de tiendas se coustruyo un pequeuo edificio para cocina, y en el otro extremo y en el medio, a distancias convenientes, dos casetas para letrinas. Estas letrinas fueron construidas para usar el sistema de cubetas dandosele tal disposicion que pueden estas sacarse facilmente para su diaria limpieza. El piso sobre que descansan las cubetas es de cemento, a fin de evitar la posible contaminacion del suelo. Los pacientes que solicitaban tratamieuto entraban en una habitacion, convenientemente dipuesta, donde se practicaba el reconocimiento miscrosco- pico de sus lieces fecales. Cuando el enfermo hacia su primer visita al Dis- pensario, sometiasele al interrogatorio expresado en una tarjeta clinica, donde se anotaban ademas todas las particularidades del caso, cuya tarjeta era nu- merada con niimero igual al escrito en otra mas pequeiia, de identificacion, que, para continuar asistiendo il la Clinica, se le daba. Esta tarjeta de identificacion solo servia para hallar facilmente la otra en la que habi'a de registrarse la consulta verificada, el tratamiento, marcha de la enfermedad, etc., etc. A los concurrentes por primera vez a la Estacion explicabaseles en poca.s palabras la causa de su enfermedail, como la contraian y lo que habian de hacer para no volverla a adquirir una vez curados. Muestras de los pa- rasitos se les ensenaban, y d los que sabian leer se les daba una cartilla, es- critaen los mismos terminos sencillos que se empleaban en la explicacion, cuyo proposito es vulgarizar el conocimiento y profilaxis de la dolencia. Esta cartilla fue tambien tlistribuida per la Policia Insular del Puesto en sus reco- rridas por la jurisdiccion. ANEMIA EN PUERTO RICO. A cada paciente se le preguutaba si tenia 6 no letrina en su casa y a su contestacion negativa — como al principio la daban todos — se le invitaba a construirla, dandole la razon de nuestro consejo. Bien pronto la noticia de nuestras advertencias corrio por la comarca, y los enfermos que acudian por vez primera a nuestra consulta, al ser interrogados, nos deeian que, 6 habian hecho ya su letrina, 6 la estaban haciendo, por que sabian por sus amigos concurrentes al Dispensario la necesidad y conveniencia de tenerla. La mayoria, en efecto, las construyo obedeciendo nuestras indicaciones, y obtuvimos de ello prueba por la palabra de los interesados, por los informes del Policia Insular, Joaquin Sanchez, destinado al servicio de la Comision, y por voz de los propietarios mas connotados del distrito. Aunque ningiin anuncio especial se hizo de la apertura de la Estacion, una ojeada al cuadro 12 permitira ver como el numero de pacientes fue en aumento hasta el punto de que la Comision se vio obligada a solicitar el concurso de dos ayudan- tes. Estos fueron el Doctor E. Canino, de San Lorenzo, y el Doctor Manuel Dueiio, de Bayamon, liabiendo este ultimo renunciando su cargo con fecha 10 de Noviembre. La concurrencia de los enfermos a la Estacion tuvo sus fluctuaciones; pero la mavoria vino regularmente de semana en semana 6 a los quince dias, de acuerdo con la indicacion que se le hiciera y con las dosis de medicamentos que liabia llevado en la visita precedente. A los que residian en sitios muy dis- tantes se les daban los medicamentos para mas largo plazo que a los que vivian en barrios proximos al pueblo, pero siempre los Sabados fueron los dias de mayor concurrencia a nuestro Dispensario excediendo en mucho a mas de 500 personas. El Consultorio no se abria los Domiugos excepto para algiin que otro paciente, de barrio muy lejano, que ignorando esta circuustancia llegaba en solicitud de tratamiento. El cuadro de visitas, arreglado por semanas, dara una idea clara del trabajo de la Estacion. El Campamento-Hospital, con sesenta camas, quedo dispuesto para el servicio, el 15 de Junio. En el fueron acogidos los enfer- mos que sufn'an las formas mas intensas del padecimiento; los que por vivir sumamente lejos no les era facil volver, a intervalos regulares, por sus medi- camentos; los que por presentar un smtoma especial 6 complicacion deter mi- nada debian ser observados cuidadosamente, y los que fueron objeto de in- vestigaciones acerca del efecto vermicida de las drogas. Desde Junio 15 a Noviembre 30, fueron admitidos 205 pacientes en distintos periodos de tiempo, sumando 7,137 dias de tratamiento de Hospital. Muy interesantes y valiosas observaciones han resultado de las investi- gaciones en lo relative al efecto del medicamento usado, analisis de orina, anatomia patologica, etc., pero como estas observaciones caen del lado de la discusion profesional, seran incluidas en un proximo informe, cuando toquen a su termino los trabajos de laboratorio ya a punto de acabar y muchos que 10 ANEMIA EN PUERTO RICO. en la actualidad henios emprendido. Somos deudores al Doctor Francisco Sein, do Lares, y al Doctor Rafael Cesteros, de Guayama, de importante material anatomico, procedente de las autopsias por ellos practicadas en sus Estaciones. Tan pronto como la Estacion Central, en Aibonito, organizo su Dispen- sario y Hospital, pusimos nuestra atenciou en el establecimiento de sub-esta- ciones en algunos pueblos de los que nos las habian solicitado. La primera, abierta en 15 de Junio, fue la de Lares, bajo la direccion del Doctor Fran- cisco Sein de aquella localidad, y despues, sucesivamente, se fueron insta- lando otras a medida que se iban haciendo los arreglos necesarios para ello. Mas, cuando ya teniamos liechos nuestros calculos y fijadoen seis el numero de Sub-estaciones que podian ser sostenidas con nuestros recursos, varias mu- nicipalidades solicitaron que se les dotara de una, a lo que nos fue, contra nuestro deseo, absolutaniente imposible acceder, ofreciendoles, no obstante, la medicacion antihelmintica y purgante para sus enfermos de uncinariasis. San Sebastian solicito de nosotros solamente los medicamentos, y en estas condiciones alli, en Barros, Moca y Patillas, se establecieron Sub-estaciones, La del ultimo pueblo, sin embargo, fue abierta a mediados de Noviembre, por lo que sus trabajos no pueden tener cabida en este informe. Los facultativos que iban a ponerse al frente de una Sub-estacion, fueron invitados a visitar la Central — con cargo al credito votado para la Comision — a fin de que observaran la marcba del procedimiento en ellas seguido y hubiera unidad, por lo tanto, en los datos e informes recogidos por todos. Este sistema de Sub-estaciones fue algo mas que un experimento, fue un exito, y una de nuestras mas legitimas satisfacciones en el trabajo; pro- bandonos la posibilidad de crear un gran numero de Estaciones de trata- miento en distintas partes de la Isla, que funcionen en armonia y bajo la di- reccion de un organismo central. Nosotros reconocemos, con satisfaccion verdadera, que ese exito se debe a los Directores de las Estaciones, sobre los cuales la Comision s«')lo ha ejer- cido una funcion puramente administrativa. Sus estadisticas se ban incluido en las de la Estacion Central para los efectos demostrativos del total trabajo realizado. A ellos se les solicito el envio de sus observaciones, acerca del movimiento liabido en su distrito en este orden de propaganda y curacion llevado a efecto en sus Estaciones respectivas, y estas observaciones, conden- sadas en breves memorias, aparecen, sin alteracion ni comentario alguno, bajo el titulo "Informes de las Sub-Estaciones." Por razones de conveniencia, liemos agrupado las estadisticas al final de este informe, y solamente insertamos aqui los resumenes de los varios cuadros al referirnos a la conclusiun que de su contenido se desprende. Esta enfermedad, es una de aquellas para la cual el bianco y el mestizo tienen predisposicion aunque pueden encontrarse, no obstante, serias manifes- ANEMIA EN PUERTO RICO. 11 taciones en el negro infectado. Nuestro trabajo se ha llevado a efecto en una parte de la Isla donde el negro es, relativamente, raro; con excepcion de dos sub-estaciones. KESUMEN DEL CUADRO 4 QUE REGISTRA EL COLOR DE LOS PACIENTES EN RELACION CON LA FORMA CLINICA DE SU UNCINARIASIS. Forma clinica Blanco Mulato Negro No regis- trado Total Muy benigna Benigna 946 3,061 7,135 3,034 384 101 349 1,111 1,343 427 48 62 83 311 228 40 8 12 182 1,378 4,483 8,706 3,501 440 357 Mediana Intensa Muy intensa No clasificados Total 14,661 3,340 682 182 18,865 18,865 RESUMEN DEL CUADRO 5 QUE SE REFIERE A LA RELACION ENTRE EL COLOR DE LOS PACIENTES TRATADOS Y EL NUMERO RELATIVO DE HUEVOS DE UNCINARIA ENCONTRADOS EN EL EXAMEN MICROSCOPICO DE SUS EVACUACIONES. Numero relativo de huevos de uncinaria Muchisimos Muchos Algunos Pocos , Muy pocos No clasificados Total Blanco 330 4,330 5,665 2,696 198 13,219 Mulato 60 958 1,355 873 43 3,289 Negro 13 142 360 153 5 673 No regis- trado Total 173 173 Mas los no registrados en Barranquitas por falta de mieroscopio Y los no registrados en Moca por igual falta Total general 403 5,430 7,380 3,722 246 173 17,354 1,425 86 18,865 18,865 12 ANEMIA EN PUERTO RICO. Por el resumen del cuadro 4 vemosqueel 78+^ de los 18,865 enfermos fue bianco, el 18+^ mulato, y solamente el 3-|-^ negro. Del nilmero total, — 14,560 — de blancos tratados, excluyendo aquellos cuya forma clinica de la enfermedad no fue clasificada, 72-f ^ fueron casos medianos, intensos 6 muy intensos, mieutras que solo el 41+^ de los 670 negros corresponde a esta clasificacioa. Por otra parte, en el resumen del euadro 5 nosotros vemos que los blancos en quienes un nilmero mediano, grande 6 niuy grande de huevos de unciuaria fue hallado en sus excrenientos, constituyen el 78-)-^ de los 13,219 blancos tratados, y que el 76+^, de los 673 negros, se encuentra en esa clasificacion. Lo que nos indica que el negro puede estar grandemente infectado, siendo tan peligroso a la comunidad como el bianco, pero que posee una relativa inmunidad para los efectos del parasito. Las edades de nuestros enfermos estan registradas en los siguientes resumenes de los cuadros 6 y 7. RESUMEN DEL CUADRO 6 QUE PONE DE MANIFIESTO LA RELACION ENTRE LAS EDADES DE LOS PACIENTES TRATADOS Y LA FORMA CLlNICA DE SU UNCINARIASIS AL SER RECONOCIDOS. Alios de Edad Forma clinica de la uncinariasis O § 1 :. u^ © Oi o 05 in © lO © i 83 -a C3 u be O la o H Muy benigna Benigna Mediana Intensa Muy intensa. No clasificada 28 77 82 43 4 6 216 371 628 1,049 830| 1,905 235 650 30 63 20 25 489 1,682 3,587 1,458 179 74 220 822 1,844 859 112 34 39 153 311 179 30 9 13 60 142 68 21 6 2 12 5 9 1 183 1,378 4,483 8,706 3,501 440 357 Total 240 1,959 4,063 7,469 3,891 721 310 212 18,865 18,865 ANEMIA EN PUERTO RICO. 13 RESUMEN DEL CUADRO 7 QUE ACUSA LA RELACION ENTRE LA8 EDADES DE LOS ENFERMOS TRATADOS Y EL NUMERO RELATIVO DE HUEVOS DE UNCINARIA ENCONTRADOS EN EL EXAMEN MICROSCOPICO DE SUS HECES FECALES. Alios de Edad Numero relative de iC c3 C3 huevos de uiicinaria O g 05 O -a 01 o CO o O •SI "So O Is I Muy poeos. . . 7 41 62 87 37 7 5 246 Pocos . . 61 487 762 1,516 715 124 49 8 3,722 Algunos 125 811 1,691 2,915 1,378 289 157 14 7,380 Muehos 33 425 1,104 2,222 1,335 239 65 7 5,430 Muehisimos.. 1 20 93 146 111 22 9 1 403 No registrados. 173 173 Total 227 1,784 3,712 6,886 3,576 681 285 203 17,354 No regi strados en Ba irranq Liitas por fait a de m icrosc( jpio. .. 1,425 Id. i( lem en M oca po r igual falta. Total riwivF 86 RAL. . 18,865 18 865 Por los cuadros precedentes podemos ver que el 72-(-^de todos uuestros enfermos fiie de 30 6 mas anos de edad. Dos hechos mereeen ser considerados en los ultimos cuatro cuadros. 1. El grado 6 forma clinica de la enfermedad se estimo solo por los signos y sintomas clinicos. Por lo que a Aibonito se refiere, los casos clasificados como medianos serian considerados como intensos en los Estados Unidos y Europa. 2. La misma observacion debe hacerse con respecto al numero de huevos de uncinaria por campo de microscopio, obtenido a favor de la combinacion del ocular 4 con el objetivo 3, Leitz: algunos, significa para nosotros de 2 a 5 por campo. 14 ANEMIA EN PUERTO RICO. Los resultados del tratamieuto se resumen en los cuadros 8 y 9 CO mo sigue : RESUMEN DEL CUADRO 8 QUE EXPLICA EL RESULTADO DEL TRATAMIENTO. CLASIFICANDO LOS ENFERMOS SEGUN LA FORMA CLiNICA DE SU UNCINARIASIS AL SER RECONOCIDOS. Forma clinica Curados En trata- miento Fallecidos Total Muybenigna. . 518 860 1,378 Benigna 1,449 3,033 1* 4,483 Mediana 2,747 5,949 10 8,706 Intensa 1,091 2,382 28 3,501 Muy intensa. .. 110 304 26 440 No elasificada. 82 100 2 1.S4 No registrada. . 173 Total 5,997 12,628 67 18,865 18,865 I * Este caso fu(5 el 5.128. que ingres6 con benigna uncinariasis en nuestra clinica. pero con una tuberculosis avanzada & consecuencia de la cual fallecio. Eu el capitulo dedicado a la prevenciou de la uncinariasis se explica la expresion "en tratamiento." Puede decirse que, proximamente, 10,000 de las 12,628 personas clasificadas "en tratamiento" estan, practicamente, curadas, ciiya cifra unida u los 5.997 da un 84 -|-^ de curados. Nuestra mortalidad, ha sido excesivameute pequeiia : solamente J+^ del niimero total ; habiendo ocurrido la mayor parte de las bajas por causa de otras enfermedades. Un calculo aproximado de las que hau ocurrido en las sub-estaciones, puede hacerse estudiando el siguiente cuadro que agrupa las perdidas por muerte habidas en los 6,152 pacientes tratados eu la Estaciun Central, en Aibonito. ANEMIA EX PUERTO RICO. 15 MORTALIDAD. ESTACION CENTRAL, AIBONITO. Fecha Fecha del Caso. de entrad a. fallecimiento. Municipalidad. Causa de muerte. 1 18 Junio 2 Julio 14 Morovis Nefritis parenquimato- sa, cronica. 296 Junio 8 Junio 15 Aibonito Uncinariasis cronica. 966 Junio 18 Julio 15 Barranquitas ! Enteritis cronica. 1182 Junio 22 Octubre 18 Aibonito Gangrena de las extre- midades inferiores de- bida al gran edema de la uncinariasis. 1315 Junio 24 Julio 7 Barranquitas Dilatacion del eorazon debida a la uncina- riasisis. 1990 Julio 9 Octubre 19 Aibonito Nefritis cronica. 2504 Julio 27 Agosto 4 Barranquitas Tuberculosis pulmonar. 2606 Julio 28 Octubre 19 Aibonito Disenteria amebica cro- nica. 2668 Julio 29 Agosto 16 Barranquitas Dilatacion del eorazon debida fi la uncina- riasis. 3325 Agosto 18 Octubre 29 Coamo Disenteria cronica. 4194 Septiemljre 9 Octubre 20 Cidra Tuberculosis laringea. 4661 Septiembre 20 Noviembre 4 Cidra Uncinariasis. 5128 Oetubre 3 Octubre 30 Aibonito Tuberculosis pulmonar. 5177 Octubre 1 Octubre 30 Cayey Uncinariasis. Todos los fallecidos, ciiyas causas de muerte estau anotadas coino debidas a otra enfermedad que a la uncinariasis, salvo el caso 5,128, tuvierou la complicacion de una intensa 6 muy intensa forma de uncinariasis. 16 ANEMIA EN PUERTO RICO. El resumen siguiente registra el niimero de dosis de antihelmmtico administrada*, y el uumeio de veces que cada caso recibio la droga. RESUMEN DE LOS RESULTADOS DEL TRATAMIENTO CLASIFICANDO LOS ENFERMOS SEGUN EL NUMERO DE DOSIS DE ANTIHELMlNTICO ADMINISTRADAS D6sis de antihelmintico Una Dos Tres Cuatro Cinco Seis Siete Ocho Nueve Diez Once Doee Trece Catorce Quince Diez y seis Diez y siete Diez y ocho Diez y nueve Veinte Veinte y una Veinte y dos Veinte y tres Veinte y cinco No recibieron tratamiento an tihelmintico No elasificados Curados TotaL 17 195 981 1.085 882 651 509 459 352 271 191 145 94 61 34 35 17 7 6 4 En trata- miento Falleci- dos 5,997 2,182 2,554 1,741 1,701 974 1.102 601 549 334 329 186 153 63 60 31 20 17 11 8 2 2 1 2 1 21 20 14 Total 12,628 67 2,220 2,769 2,736 2,793 1,860 1,753 1,110 1,008 686 601 377 298 157 121 65 55 34 18 14 6 2 1 3 1 2 173 18,865 Total de dosis de antihelmintico. 89,908 ANEMIA EN PUERTO RICO. 17 Invitase la atenciun al ciiadro 1 ciiyo resiunen es el siguiente : RESUMEN DEL NTJMERO total DE ENFERMOS DE LAS DIFERENTES MUNICIPALIDADES, OBTENIDO FOR LOS DATOS DE TODAS LAS ESTACIONES. Municipalidad de Aibonito Barranquitas. . Barros Comerfo Coamo Utuado Guayama San Sebastian. Moea Lares Cidra Cayey Morovis Caguas Naranjito Aguas Buenas. Salinas Corozal Fajardo Ciales San Juan Arecibo Juana Diaz. . . . Santa Isabel . . . Bayamon Ponce San Lorenzo. . . Patillas Arroyo Hatillo Adjuntas Las Marias . . . . Camay Total. 3,774 1,868 1,550 1,644 1,531 2,058 623 746 86 3,457 694 190 81 5 122 26 13 17 1 19 2 67 7 8 18 3 2 104 8 27 94 14 6 18,865 I De este resiimen se deduce lo que sigue : 1. En aquellas miuiicipalidades en que opera una Estacion de la Comi- [sion (las primeras diez de la lista), el tratamiento de personas infectadas ha isido activamente realizado. El valor profilactico de este trabajo es, per tanto, enorme, como puede verse per el gran numero de tratados. 18 ANEMIA EN PUERTO RICO. 2. En otras Municipalidades, como Cidra, tal interes la campana ha despertado, que podria asetrurarse igual resiiltado que en las que ha habido Estacion. 3. En otros pueblos, generalmente distantes de las Estaciones, la influencia de la canipaiia se deja sentir porque es tema de eonversacion, sobre todo, entre las clases trabajadoias, las curaciones ven'ficadas en individuosde esas Municipalidades que han logrado tratamiento. Es, seguramente, de esperarse que, cuando un niimero de personas de los Municipios vecinos se ha cuvado, ostos ^Municipios soliciten el establecimiento de una Estacion en la localidad, debido H la pio])aganda hecha por los que, autorizados por su propia experiencia, pueden hablar. El siguiente resumen del cuadro 2 pone de manifiesto el NUMERO DE VISITAS HECHAS POR LOS ENFERMOS A LA ESTACION CENTRAL, EN AIBONITO, AGRUPADOS SEGtJN LA MUNICIPALIDAD DE QUE PROCEDIE^RON. Munieipalidad. Aibonito Barranquitas Barros Comerio ... Coamo Cayey Cidra Morovis Caguas Naranjito Aguas Buenas Salinas Coro/.al Utuado , . . . . .San Juan Areci bo Jiiana Diaz Fajardo dales Santa Isabel Total Ntim. de Vlsitas. 16,095 2,207 879 603 1,935 522 2,271 2 6 25 16 26 11 5 6 1 9 2 1 6 24,628 Este resumen demuestra que, relativamente, las cortas clistancias influyen. en el campesino para la continuacion del tratamiento ya empezado. El numero de pacientes de cada Munieipalidad que verificaron sus visitas a las ANEMIA EN PUERTO RICO. 19 Estaciones respectivas se encontrara, con detalles, en el cuadro 12, cuyo resumen vti li continuacion : RESUMEN DEL CUADRO QUE REGISTRA EL NIJMERO TOTAL DE YISITAS HECHAS FOR LOS ENFERMOS A LAS DISTINTAS ESTACIONES. Estaciones. Aibonito Barranquitas . Barros ... Coamo Comerio Guayama . . . . San Sebastian Moea Utuado Lares Paeipiites que cmpie- zaii el trata- mieiito 6,152 1,425 1,255 1,048 1,676 746 663 86 1,813 4,001 18,865 Pacientes que vnel- ven para contimiar el tratamieiito 18,476 6,113 5,536 4,730 7,830 1,228 1,419 105 3,841 8,272 57,545 Total Visitas. 24,628 7,538 6,791 5,778 9,506 1,969 2,082 191 5,654 12,273 76,410 Personas en cuyos excrementos no se encontraron huevos de uneinaria. Este dato se refiere a la Estacion Central. . . . 486 Total. (6,896 El enorme niimero de visitas, puesto de manifiesto en el cuadro 12, en cada una de las cuales un personal conocimiento del estado y mejoria del paciente tuvo lugar, un examen miscroscopio de sus excretas se practice, la oportuna prescripcion fue escrita j despachada a poco, los dates registrados en la tarjeta clinica y los demds detalles pertinentes al caso merecido la consideracion debida, demuestra, todo esto, el inmensotrabajo realizado y el que es posible llevar a efecto procediendo de acuerdo con las lineas generales trazadas por la Comision en el ano que acaba de terminar, y para cuya obra en el porvenir, solicitamos toda la amplitud necesaria. Un heclio importante salta a la vista cuando se examina el cuadro 3, en el que la residencia de los pacientes que concurrieron a la Estacion Central, esta en relacion con el grado de su enferniedad agrupandolos por millares sucesivos. Se ba dicho que el campesino busca la novedad y el aire de misterio que rodea a un laboratorio clinico, en el que muclios instrumentos extranos se presentan a su vista, y repetidos examenes de sangre, de excrementos, de 20 ANEMIA EN PUERTO RICO. orina, etc, se practical!. Aunque no nos detenganios a discutir la parte humana que todo pueblo ha de niostrar en tales circunstancias, la Comision estit persuadida, de que el campesino no viene a nuestra consulta desde su remoto barrio por motivo tan fi'itil. El busca su salnd, por largo tiempo quebrantada, y no busca otra cosa. La prueba de esto la tenemos eu el mismo cuadro de referencia. Cuando nosotros empezamos a recibir enfermos en la Estacion de Aibonito, y durante dos meses sucesivos en que no funcionaba estacion en Barros, Barranquitas, Coamo, Comen'o, C'idra y Cayey, el niimero de visitantes procedentes de esas municipalidades fue considerable. Eu Agosto se establecieron las Sub-estacioues de Barranquitas, Comerio, Barros y Coanio. En estas estaciones, no liabia laboratorio propiamente dicho, sino solo medicos competentes que realizaban el trabajo en una pequeiia oficina montada con sus propios personales recursos y ayudados por el entusiasmo de las autoridades municipales. Desde entonces los enfermos procedentes de esos Municipios empezaron li faltar n, nuestra clinica. Ellos sabian ya que el mismo tratamiento empleado por nosotros se seguia en aquellas Sub-estaciones, en ellas eran benevolamente recibidos, y como su unico y principal objeto era obtener su curacion, y alli la lograban, no tenian para que venir donde nosotros y no venian. Por el contrario, el niimero de enfermos de Cayey y especialmente de Cidra, donde no hay Sub-estaciones, fue en aumento estando ambos pueblos, sobre todo el ultimo, muy distantes de Aibonito. Por lo que se ve nuestro campesino aprovecha la oportunidad de obtener su salud y no se preocupa de la novedail que le brinde un local mils 6 menos aparatoso. Los efectos producidos por las drogas timol y naftol-beta han sido cuida- dosamente estudiados por la Comision, y discutimos su valor relativo en el capitulo dedicado a la profilaxis. Ambos medicamentos son excelentes, y sus resultados, asi como los usos que cada uno especialmente tiene, junto con nuestros dates en este orden de investigacioues, tendnin cabida en nuestro proximo informe. Baste, por ahora, decir, que el repetido uso de estos antihelminticos, semanalmente, por dos 6 tres meses, en los cases en que se ha sufrido una intensa anemia, no es prudente. El naftol-beta, en tales casos, puede aumentar la irritacion existente en el riiiun, causada por la enfermedad, y agravar el proceso. No diremos, por esto, que este contraindicado su uso, sino que debe tenerse en cuenta esta accion en ciertos casos. El timol, es menos irritante. Por lo demas, nosotros creemos que cinco dosis sucesivas de cualquiera de estas drogas, son suficientes, en terminos generales, para lograr en un paciente de uncinariasis, si no su tecnica curacion al menos una ANEMIA EN PUERTO RICO. , 21 curacion relativa, pudieudo aconsejarle la viielta al cabo de iin mes para repetirle el antihelmintico si lo necesitare. Es, pues, el tratamiento especifico de la anemia de Puerto Rico, un liecho evidente y esta fuera de toda discusion. La larga lista de cura segura, por pildoras de hierro patentizadas, polvos, restauradores de la sangre y del sistema nervioso, tan cariiiosamente solicitados y pagados por el infortiinado y credulo jibaro, aquel que esta, entiendase bien, pobre, con liambre, ya es hora de que sea borrada no solo por los hombres de ciencia sino por la general protesta de las conciencias honradas. El tiempo transcurrido desde su empleo es suficiente garantia de la completa ineficacia de cualquiera de esas prepara- ciones para curar, porque ninguna de ellas ha operado las maravillosas curaciones que pregonan ni ban podido tener carta de verdad ni uso solo de sus asertos. Si lia proporcionado a muclios su enriquecimiento el sudor de millares de infelices que gastan sus viltimas economias para obtener su salud y vigor, prometidos de ese modo, logrando al cabo un amargo desengano- Hora es ya, de desterrar la perniciosa costumbre de fiarse en la medicina patentizada, y es bora ya de que la medicina cientifica recobre en Puerto Rico, por el propio medico, el territorio ocupado por el comercialismo que explota la fe inocente de nuestro pobre campesino. Con relacion al hierro y sus preparaciones, debe ser conocido que la Comision ha abandonado su uso aun en la presencia de un 8^ del valor de la sangre de un paciente de uncinariasis. Muchos de nuestros Directores de Estaciones estan adoptando esta misma posicion nuestra, y como el trabajo les familiariza con el insignificante valor de los marciales, gradualmente los van abandonando alii donde al prineipio, como nos ocurrio a nosotros, se ha con- siderado condicion sine qua non su uso en el tratamiento de la anemia por uncinariasis, despues de la medicacion especifica. No es oportunidad la de ahora para tratar detenidamente este asunto, pero mucho tenemos que decir acerca de el en nuestro informe proximo, donde muy interesantes compara- ciones se haran entre casos tratados con hierro despues del tratamiento espe- cifico antihelmintico y casos donde los ferruginosos no fueron usados. Hemos hecho mencion aqui de el porque el bullicioso tropel de vendedores de patenti- zados ferruginosos esta ansioso de recomendar sus preparaciones, basando su supuesto valor en el informe anterior de esta Comision. del que no otra deduccion puede ser liecha mas que la justa y recta, aunque poco favorable para ellas, que se desprende del capitulo dedicado al tratamiento de esta enfermedad. Harto conocemos el valor relativo del hierro en la uncinariasis que no es otro que el mismo 6 acaso menor, que el que tiene en el tratamiento de la malaria 6 de la sifilis. Seanos permitido dedicar este espacio al reconocimiento de la ayuda pres- tada por numerosos amigos nuestros a los trabajos de esta Comision. Ademas 22 ANEMIA EN PUERTO RICO. de aquellos que lian toniado parte activa en la labor contribuyendo a su exito, y que son acreedores a nuestra gratitud sincera, nosotros deseamos expresar nuestro profundo agradecimiento por sus valiosos servicios, al Farmaceutico de Aibonito, Lcdo. Don Teodoro Moscoso. La Comision, al mismo tiempo, desea hacer constar aqui el interes y asiduidad con que sus ayudantes en la Estaciun Central, Doctores E. Canino y JNIanuel Dueno, ban cumplido los deberes que se le confiaran. PREYENCION DE LA UNCINARIASIS EN PUERTO RICO. Como ocurre la infeccionf La Comision, como resultado de sus investigaciones durante dos ailos de experiencia, ha llegado a la conclusion de que, si no en todos, al menos en el 99^ de los individuos que portan la Uncinaria en su canal intestinal, el pard- sito efectiia su entrada en el organismo a traves de la piel puesta en contacto con suelo 6 agua que contengan las larvas. En otras palabras, nosotros sabemos que el labriego descalzo, en suelo infestado, que contrae la llamada mazamorra tan familiar en nuestra gente de campo, ha sido invadido por uncinaria. La marclia que se sigue en el proceso de infeccion, es la siguiente: El parasito vis'^e en el intestino del hombre. Un caso ordinario de un- cinariasis, como los que se ven tan frecuentemente aqui, expulsa con sus heces fecales diariamente mas de un millon de huevos, que los vermes hem- bras han depuesto en la parte superior de los intestinos delgados. Estas heces depositadas en sitios donde la sombra, humedad y temperatura les son favorables, permiten el desarrollo de los huevos en innumerables pequeiiisi- mos gusanos, las larvas, dispuestos a penetrar por la piel del hombre, en busca de su intestino, punto de eleccion para la vida del parasito. Afortu- nadamente estas larvas no pueden reproducirse fuera del cuerpo humano, ni les es dado vivir indefinidamente en la tierra, aunque no sepamos el limite natural de su existencia. En el individuo portador de un corto numero de vermes, los sintomas de infeccion, son generalmente pocos, 6 no se manifiestan, y ese individuo es por tanto menos peligroso para la comunidad en que vive, que el muy en- fermo que los lleva en gran numero. La mazamorra es el primer signo de infeccion por la uncinaria y si los ataques son de importancia y repetidos, la uncinariasis ocurre. La Uncinariasis, es la condiciun 6 estado resultante de la invasion por uncinaria, en numero tal, que se venzan las resistencias naturales del sujeto contra el veneno elaborado por el parasito residente en el canal intestinal. Los efectos de este veneno, se manifiestan por ciertos notables trastornos en las funciones de organos importantes. Mientras los sintomas de la enferme- dad son, generalmente, perdida de fuerzas, mareos, dolores vagos en el pecho y estomago, sin palidez notable, es tambien muy comiin observar alteraciones de la sangre, mas 6 menos graves, resultando la anemia, sintoma de una 24 ANEMIA EN PUERTO RICO. intensa uncinariasis, que con mucha razon el profano teme, tras largos afios do amarga experiencia. Esta es la condicion lamentable que algunos periodicos continentales han dado en llamar "la enfermedad de pereza." De los siutomas apuntados pasase a la liidropesia, a la fatiga del corazon y al completo aniquilamiento y nnierte de un hombre en la flor de su vida, termino d que conduce un pardsito tan facil de ex pulsar, pero que hace vic- tima^s j)or la incredulidad en las leyes, que pudieramos llamar matematicas, de nuestra profesion. Nosotros sabemos que es una piiblica calamidad en Puerto Rico la anemia, que es una enfermedad, no una manifestacion de insuficiente 6 im- propia dieta, ni es la expresion de la pobreza de miles de indigentes en la Isla. Que estos existeu y que el regimen alimeuticio del campesino es defec- tuoso, es cosa que, aunque nos sea conocida y lamentada, no nos toca come medicos resolver. Solo como higienistas y medicos intervenimos en la cuestion, y, desde nuestra posicion, consideramos que tanto el individuo muy enfermo, como el que aparenta buena salud, si estan iufectados por uncinaria y defeoan en sitios dontle otros han de poner mas tarde su planta, riegan la semilla de la enfermedad que a caso la contraiga alguno de su propia familia. Como prueba, en parte, de nuestra creeucia en la infeccion por la piel, referimos el hecho de que solo un 4-f-^ de los infectados, negarou haber pade- cido de mazamorra. Aunque es muy corto el numero, aun puede hacerse menor, si tenemos en cuenta que muclios no hacen memoria de si la padecieroa y otros la uiegan porque estiman humillante haber la sufrido. La certeza de estas suposiciones la hemes obtenido en diferentes casos. Sin embargo, de 486 personas que solicitaron tratamiento en Aibouito, y en las cuales ni liuevos de uncinaria se eucontraron en sus heces ni acusaban anemia, solamente 234 manifestaron haber padecido mazamorra, pero fue en fecha tan remota que, seguramente, todos sus vermes habian llegado al termino natural de su exis- tencia, u lo que es lo mismo, habian muerto de vejez. Toda otra via de invasion es rara, al menos en Puerto Kico, y no me- rece el espacio necesario para discutirlo. Ahora bien: donde ocurre la infeccionf Las conclusiones de la Comision se basan en estos dos hechos: L Es costumbre general en los campos de Puerto Rico defecar en el suelo, alrededor de la casa, bajo los arbustos 6 en los platanales que circun- dan los bohios. El campesino, que no tiene letrina, "vaal monte", es decir, al pequeno bosque que esta proximo a su vivienda, y alii deposita sus excre- mentos. Como generalmente, en el interior de la isla, tales bohios estan en las cercanias de los cafetales, vienen a ser estos los retretes de los vecinos, ademds de serlo de todos los trabajadores que durante las horas de labor en ANEMIA EN PUERTO RICO, 25 epocas de siembra, limpieza 6 recoleccion. se veu impelidos a desalojar sus intestinos. 2. (a) El huevo, para alcauzar el grado de maduiez que libere el embrion, necesita condiciones apropiadas de sombra y hiimedad, y la larva peligra si se seca el medio en que se encuentra. El huevo resiste meuos esta ultima influencia, que la larva completamente desarrollada. (bj Todos los restos vegetales en descomposiciou, especialmente los detritus de los pliitanos, constituyen un medio favorable para la protecciou y sostenimiento de la larva. Es, por tanto, nuestra conclusion en este punto, que los cafetales de Puerto Rico, ofrecen las mejores condiciones para la madurez del huevo y para el desarrollo y sostenimiento subsiguiente de la larva. Solicitamos la atencion hacia el cuadro 10 del capitulo Estadisticas, de cuyo contenido damos aqui un resumen. RESUMEN DEL CUADRO 10. QUE PONE DE MANIFIESTO EL NUMERO TOTAL DE LOS PACIENTES CLASIFICADOS DE ACUERDO CON EL SITIO MAS FRECUENTE EN QUE ADQUIRIERON SU MAZAMORRA. Cafetales 11,6(50 Cafetales y cercanias de la vivienda 1,099 Pastes 977 Cercanias de la vivienda solamente 461 Caminos y veredas 2,201 Rios, quebradas y eharcos 165 Calles de las poblaciones 161 Establos y corrales 703 Platanales 161 Siembras de tabaeo 19 Batatales 2 Cercanias de Escuelas publicas 17 Caiia verales 28 No clasificados 420 Personas que con huevos de uncinaria en sus evacuacio- nes, negaron haber padecido de mazainorra 791 Total 18,865 La pregunta ^donde adquiriu U. su mazamorra?, fue contestada por el 67 -f- % "en la fiuca. " Como nosotros estabamos operando en el interior, esa liltima palabra llevaba sobre entendidas, las "de cafe." La referencia a "la tinea" liecha, es, pues, a los cafetales. Cuaudo alguno indica que ha adquirido su infeccion en los alrededores de su casa, generalmente se refiere a su inmediata proximidad, no en la sombra del vecino bosque, sino en el patio 6 en el batey de la vivienda. 26 ANEMIA EN PUERTO RICO. Totlos los otro8 sitios niencionados, son siempre lugares humedos mas 6 menus aljonados jior excremento huniano, y hasta los que no llega el sol para secarlos. La sim])le accion de este, no basta para matar la larva, pero retarda su desarrollo, y la sequedad del medio efectuara su destruccion. Las infecciones en los rios y quebradas, tienen lugar por medio del lodo de la orilla de estos caudales de agua, m:is no por la ingestion del liquido corriente. Muchas lavanderas y aguadores, contraen de este modo la enfermedad. Las plantaciones de tabaco y los caiiaverales, no son tan peligrosos sitios de infeccion, salvo ciertas zonas que no reciben la luz directa del sol 6 que tienen siempre agua de regadio y en las cuales la larva encuentra un terreno excelente para su desarrollo. En todas las partes de la Isla donde el cafe no sea su primer pro- diu'to, conio en la costa, la infeccion proviene de las cercanias de la vivienda. Aunque la Comision esta plenamente convencida de que los cafetales seran siempre las fuentes principales de infeccion para la poblacion del interior, y en aquellos incluimos los alrededores de la vivienda como parte de los mismos, en la mayoria de las veces, como demuestra el euadro 10, no hay sitio libre de contaminacion porque el campesino defeca donde quiera. En el periodo de las lluvias no solamente estan las larvas mas extensa- mente esparcidas sino que es, precisamente, entonces la epoca de la recolec- cion y el labriego concurre en mayor numero a los cafetales. Y aunque la lluvia no sea continua, es en cantidad bastante para mantener humedo el suelo alli donde la falta de sombra de la arboleda pudiera secarlo. Es, entonces, que ninos y mujeres y hombres van descalzos al trabajo de la recoleccion del cafe, unica ocupacion de algiin beneficio pecuniario que acaso tengan en todo el ano. Las fruslerias para las Pascuas y las inocentes tradicionales diversiones de esa epoca, sin hablar de la ropa que ban de comprar para el ano siguiente, dependen del pequeno jornal ganado en la cosecba durante dos 6 tres meses. Por eso es que en la cosecha de cafe, que representa para los mas la unica fuente segura de ingreso de todo el ano, dejan de concurrir temporalmente en mayor 6 menor numero a nuestras Estaciones de tratamiento apesar de las linsias con que vienen en demanda de curacion para su terrible dolencia. Tan lastimoso como cierto es que miles de ellos van en busca de su muerte alli donde realizan el trabajo que ha de asegurarles el pan do su familia! Muchas veces hemos oido en contes- tacion d nuestra pregunta "donde adquirio Vd. la mazamorra?" esta re- puesta "durante la ultima cosecha." He aqui, como en ese trabajo de recolectar el grano en los cafetales, se va sembrando la enfermedad y la miseria para la cosecha anual de vidas. ANEMIA EN PUERTO RICO. 27 que las estadisticas de sanidad de la Isla registran con el numero corriente de 5 a 7,000 imiertes por anemia ocurridas cada ano. Como generalmente el labrlego y su familia, en este pais, van descalzos en la epoea de las lluvias, la mazaniorra se adquiere donde quiera, de modo que multiples repetidas infecciones acaban por desarrollar la eufermedad, y cualquier aumento en el numero de los parasitos puede matar al ya gemi-eufermo campesino. La anemia de Puerto Kico es una enfermedad, es un padecimiento infeccioso, no una ('ondici('»n inherente. ni un aootamiento de fuerzas vitale^^, ni el termino natural de la existencia del liombre aqui. Es cierto que ella abate y depaupera todos los organismos, cualquiera que sea la edad que tengan; es evidente que el desarrollo mental retarda, que el cuerpo debilita y el espiritu deprime, al punto de que el termino medio de los traba- jadores de este pais, donde la agricultura es su primer fuente de riqueza, esta enervado, sin esperanzas de mejoramiento y sin fuerzas ni poder bastante para valerse a si propio. Frecuentemente, ese labriego enfermo no puede ganar lo suticiente para el sostenimiento de su familia y en ese hogar se come solo el alimento que proporcionan los frutos silvestres del pais. Y nos referimos a una gran masa de pueblo cuya sangre en un promedio tiene un 50^ menos de la que normalmente debiera tener. Mefodo que debe segiiirse en una campana contra la Anemia de Puerto Rico. Despues de muchas y serias discusiones, la Comision ha llegado a fijar de una manera permanente su posicion, eon respecto a los esfuerzos que en pro de la extincion de esta plaga deben llevarse a cabo. Nosotros creemos que el tratamieiito de toda persona afectada de uncinariasis encierra el secrete del exito en la luclia contra la enfermedad. Para sostener esta posicion nos apoyamos en la respetable opinion medica de la Isla y en las practicas seguidas por luglaterra, Alemania, Francia y Belgiea que combaten el mismo padecimiento en sus miiias. Otras medidas, sin embargo, pueden tomarse y algunas deben marchar, por nece- sidad y conveniencia, unidas, como es la ensenanza de las medidas que deben tomarse para evitar la enfermedad, ensenanza que liabra de ser dada en las Estaciones y Dispensarios. No es nuestra finalidad solo curar nuestros pacientes sino liacer inocuas las deposicioues de miles de individuos que continuaran Uefecando en el suelo apesar de las predicas, conferencias, avisos y prohibiciones. En las Estaciones para el tratamiento y prevencion, que sera el mejor de los sitios para enseiiar, sabra el que busca su salud porque el esta enfermo, como puede evitar el contraer de nuevo su dolencia, y como una vez curado no habra de propagar, al menos relativamente, su enfermedad. Q^ue esta finalidad puede ser lograda lo demuestra, de una 28 ANEMIA EN PUERTO RICO. manera evidente, nuestra experieneia eii Aiboiiito y la tie los Directores de Estaciones en la Isla. Cada persona que solicita trataniicnto en la Estacion, sufre piimero un exainen microscopico de sus heces fecales. Si en ellas se encuentran huevos de uncinaiia, tlaseie uno de los verniifugof* en uso i)ara que lo tome en su casa. Entonees instriiyesele de la causa de su enfermedad, muestran- sele los ])arasltos que la originan, como ellos son capaces de producir el estado en (|iie el solicitante se encuentra y como puede protegerse de futuros ataques. Invitaselc a volver semanalmente trayenilo una pcqueiiisima cantidad tie sus excrementos, que van siendo examinados hasta que no aparezcan los huevecillos del gusano, y la curacion se efectue. Los resultados de seis meses de trabajo, cumplidos el primero de Diciem- bre de 1905, se encontraran, en detalle, en el capitulo Estadisticas de este Informe. El gran niimero de personas que en tan corto tiempo ban solici- tado tratamiento, es uuis elocuente que las palabras. Esta es la muda apelacion del ji'baro, para mejorar su condicion, dirigida al afortunado que corre poco riesgo de contraer la enfermedad y que recibe, al menos iudirecta- mente, el beneficio de sus brazos. Nosotros no creemos que ante la evidencia de los lieclios, ante el total de 18,798 personas curadas o en tratamiento, que ban concurrido a nuestras Estaciones en tan corto plazo, pueda dudarse de la necesidad de continuar esta campana. En Aibonito, donde proximamente la mitad tie su poblaciou total lia estado en tratamiento, dicese, que la mazamorra es mucbo meuoa frecuente que el ultimo ano. Cosecberos de cafe asi lo aseguran. Como resultado de nuestra ensenanza en la Clinica, el campesino ba construido su letrina temiendo menos a la multa 6 prision que su carencia apareja, que a la enfermedad de que se acaba de librar. Y es justo decir, que el caracter del hombre a quien nosotros nos dirijimos en su ayuda es tal, que una vez convencido de la utilidad que se deriva de nuestro consejo, es muy tolerante con la reforma impuesta en su favor. Pero el necesita el efecto moral de la inspeccion y de la ley. El esta acostumbrado a oir decir lo que nunca ba de baeer mientras la ley no venga a exigirselo. Apesar de esto, ninguna ley asegurara el cunq)limiento de un principio de bigiene publica 6 privada mientras no se conozca la razon que justifique su observancia. Y la razon del jirincipio y la razon de la ley la obtiene el campesino en las Estaciones donde oye liablar de su enfermedad, ve los gusanos que la originan y donde se le ensenan los medios de que ha valerse para evitar el padecimiento. No bay que esperar que la mayoria pueda leer ningun impreso que explique la dolencia ni los medios de evitarla. Esto queda reservado para los duefios de tineas y otras personas a quienes les sea permitido este medio de infor- macion. Para los concurrentes en demanda de remedio, la explicacion de viva voz es de resultados positivos. Por eso, abogamos por la organizacion ANEMIA EN PUERTO RICO. 29 de un cuerpo de inspectores, conocedores del campesino, que ganen su confianza, y los cuales, siendo de superior cultura que el, puedan, sin embargo, hablarle eon los mismos modismos que el emplea, vivir su vida e ideutifi- carse con sus pensamientos. Estos inspectores irian de casa en casa demos- trando la necesidad de la reforma sanitaria, haciendolo de una manera convincente y de modo tal, que se obtenga lo que no podria lograrse con medidas proliibitorias. Ellos podrian bablar de la verdad que en las Estaciones se demuestra, aconsejarian la concurrencia a los Dispensarios, transportarian a los muy enfermos a donde pudieran ser convenientemente asistidos, y descubririau a los contraventores de la ley a los cuales los Tribunales se encargarian de juzgar. A fin de completar los esfuerzos del medico y de los inspectores, nosotros creemos que todos los propietarios de tineas rusticas, especialmente las de cafe, debidamente informados del tin que la ley persigue, debiera requerirseles para que sus trabaj adores, peones, etc, no defecaran sino en una letrina adecuada o en un lioyo proximo al sitio donde aquellos trabajan, cuya vigilancia debiera encomendarse a algun empleado especial. El uso de zapatos debe ser aconsejado en las escuelas y donde quiera que se ofrezca oportunidad a la conversacion entre patronos y empleados 6 estancieros y peones. No bicimos en nuestro iuforme anterior, mencion de este consejo, no por que no conocieramos su importancia como una eficaz medida preventiva, sino por que estimamos su recomendacion prematura. Cuando se emprenda la campaiia contra la enfermedad, lleyando a la practica este plan, todas las medidas importantes alcanzaran su completo desarrollo, y se cumplira la ley por la oportunidad que para cumplirla se brinda a todos conociendo el espiritu que la informa. Desde el principio de nuestros trabajos, comprendimos la necesidad de asegurarnos del valor relativo de las drogas aconsejadas para el tratamiento de la enfermedad 6, en otras palabras, la necesidad de conocer el niimero de uncinarias expulsado por cada dosis sucesiva de antibelmintico. El cuadro 13, pone de manifiesto los resultados de esta investigacion, limitada a las drogas timol y naftol-beta por que el extracto de lielecho macho no pudo ser objeto de ella debido a la razon siguiente. Usamos un extracto etereo de lielecho macho procedente de una reputada casa de drogas alemana y, practicamente, ninguna uncinaria removio, por lo que nos vimos precisados a abandonar el uso de este medicamento en la creencia de que, como se dice, el clima habia alterado su composicion debilitando su poder vermicida. Sin embargo, empleamos luego un extracto solido fresco del mismo lielecho, adquirido en una de las mas acreditadas casas de drogas americanas y no obtuvimos mejor resultado; auiique se dejaron sentir los efectos cousecutivos a su administracion, como mareos etc. El mayor 30 ANEMIA EN PUERTO RICO. lulniero de uiicinarias expulsado por cualquiera cle las dos preparaciones fue 8, mientias (pie, una subsijriiiente administracion de las | partes de la dosis uj^ual de timol hizo expulsar 8,686 gusaiios en el mismo caso. E\ tiniol fue administrado a 40 casos del Hospital con inteivalos de una seniaiui. Todos los excrenientos evacuados en las 24 horas siguientes d la en <|ue se adniinistro el antihelniintico fueron guardados, lavados sobre un jiedazo de gasa jwr individuos expertos y el rosiduo colocado en una solu- cion de fornialina al 10%. De este residuo las uncinarias se recogiau con pin /.as V se contalian por nosotros. El naftol-beta fue administrado a 30 casos del Hospital en las misnias condiciones. Los resultados de la Coinisiou en este orden de experiencias son : Que despues de una dusis de tiniol el 76.85% de todas las uncinarias contenidas en el canal intestinal fue expulsado, y despues de una dosis de naftol-beta lo fue el 72.24%; despues de 2 dosis de timol 90.17^' del nnmero total fue expulsado. " " " " naftol-beta 88.12,^; " •• 3 •• " timol 95.28,'? " ' " ** naftol-beta 93.67r; " " 4 " " timol 96.57,'r " " " " " " " " " naftol-beta 96.47,'? " " " El resultado notable obtenido con la priinera dosis, desconocido paia la Comision hasta que se hizo esta desagradable, pero niuy iinportante investi- gacion, lia influido en nuestras ideas acerca del trataniiento y protilaxis de la dolencia. Por. largo tieuipo la Comision ha visto casos clinicaniente curados de su anemia despues de una 6 dps dosis de autihelmintico, principal- meiite en los casos muy benignos, benignos y medianos. Sin embargo, al ser examinadas sus heces algunos buevos de uncinaria se encontraron. Nosotros comprendeinos ahora la significacion de este fenomeno y por que muchos casos dejan de volver. Es, porque ellos se sienten bien, y no veil la necesidad de solicitar nuevo medicamento. Cuando un paciente expulsa de I a ^^ /^q de los parasitos que causan su enfermedad y los pocos que le quedan no pueden reproducirse (como es bien sabido), o no acusa smtomas su enfermedad 6 la mayor parte de ellos ban desapa- recido. Por tanto, los que nosotros liemos considerado curados ban side cientificamente curados. A los 5,997 casos incluidos como curados, podria- mos sumar casi 10,000 de los 12,628 clasificados "en trataniiento" por que estiin realmente lilires de su anemia y de otros sintomas y se dedican a sus babituales ocupaciones sin las molestias de la enfermedad que mas 6 menos les impedia realizar su trabajo. Los incluimos en la clasificacion "en trataniiento " porque 6 tienen todavia algunas uncinarias eu su canal intestinal u porque ban dejado de volver al Dispensario, lo que no nos permite, por la })resencia de algunos huevos del parasito eu sus evacuaciones AXEMIA S:N PUERTO RICO. 31 en el primer caso, claries por tecnicamente curados; pero lo estaii en cuanto a, la evidencia de su enfermedad concierne. Adenias, en cuanto al poder inf'ectante de tales personas, no completa ni teenieamente euradas, como hemos definido anteriormente, encontramos, por un calciilo basado sobre los datos contenidos en los cuadros 9 y 13, que nos ha sido posible reducir cerca de 94.5^ en los 18,865 casos tratados, su poder de propagar la enfermedad contaminando el suelo, y que 12,628 casos, incluidos como todavia en tratamiento, son aliora solamente un 8.5$^ peligrosos, como portadores de vermes y propagadores de la enfermedad, que lo eran antes. Estos liechos nos llevan a, las mas valiosas conclusiones. 1^ En terminos geuerales, 5 dosis de timol son bastantes para curar, practicamente, a un paciente de uncinariasis. Excepcionalmente, mas de cinco pueden necesitarse y menos de cinco ser suficientes. 2^ Este numero de dosis, generalmente, dismiuuye el peligro de un enfermo para la comunidad, en relacion a su poder de infectar el suelo, cerca de diez y nueve vigesimas. 3^ En el tratamiento de enfermos en su casa, el naftol-beta es, in- dudablemente, inferior al timol. En el Hospital todos los casos a quienes se les administraba cualquier autihelmintico, se les sometia a una dieta pre- paratoria, estrictamente de leclie, durante 24 horas. La droga actuando entonces mas directamente sobre el parasito, no protegido por las sustancias alimenticias en un iutestino lleno 6 parcialmente lleno, daba un resultado no muy diferente de una a otra droga; pero en la prescripcion de los autihelmin- ticos para ser tomados en la casa, el paciente a pesar de nuestra recomenda- cion, no obedece siempre nuestras instrucciones dieteticas. En tales circuns- tancias el timol es mas eficaz que el naftol-beta, porque, con pocas dosis del primero, desaparecen mas pronto los huevecillos en las evacuaciones y el enfermo recupera sus fuerzas con mayor rapidez. EL PKOBLEMA 1)E LA UNCINARIASIS EN PUERTO KICO Y SU SOLUCION. Las conclusione? a quo lia llegado la Comision, por virtiid de su labor en el aiio que acaba de tenninar, son la? siguientes: la — Posibilidad de t^upriinir la uncinariasis en Puerto Eico con el caracter epidemico que lioy tiene, por razon del vasto numero de invadidos. 2* — Necesidad, para ello, de una canipana de profilaxis por medio de Dispensaries 6 Estaciones de tratainiento que realicen la obra inmediata de la curacion, y leyes adecuadas al fin perseguido. 3* — Conveniencia de organizar un cuerpo de medicos conocedores del asunto, de las condiciones del pais, y del campesino, que lleve a cabo la empresa de exterminar la plaga. Y 4^ y ultima, necesidad y conveniencia a un tiempo, de votar recursos suficientes para esta campana que debe continuar bajo la direccion y prose- guirla el Gobierno Insular que la inicio. Cuando se analizan, fria y desapasionadamente, nuestras estadisticas acerca del movimiento de enfermos babido en las distintas Estaciones que con la Central de la Comision en Aibonito, ban funcionado en la Isla a partir del 1? de Junio al 80 de Noviembre del ano ultimo, se evidencia la ansiedad vehemente de alivio y curacion de la enfermedad que aqueja d nuestra poblacion rural, ansiedad qne bace venir de los barrios mas distantes de los pueblos comareanos al en que funciona un Dispensario, a nuestros pobres cam]3esinos. Pueblo que asi sufre, que venciendo las rancias creencias de que una alimentacion especial es necesaria cuando se toman medicinas sigue la indicacion del medico y vuelve al Dispensario, en busca de sus medieamentos, recorriendo para ello largas distancias, tantas veces como se le exige; que atento a la explicaciun que se le bace de la causa de su dolencia se apercibe a poner en practica los consejos que oye para preservarse de ella, es pueblo que merece toda la consideracion de las autoridades que le gobiernan, para la preservacion y tratamiento de la enfermedad que le enerva y le mata. De el puede esperarse, divulgando los conocimientos de la Higiene al par que se le cura, el triunfo de la educacion, para extinguir la plaga que le azota. No de otra suerte que con un criterio optimista podemos juzgar a ese pobre labriego que busca remedio para el y los suyos — sacrificando ANEMIA EN PUERTO RICO. 33 •d veces el trabajo de uu dia, unico ingreso con que cuenta para atender a sus perentorias necesidades, pero cuya perdida conoce como ganancia en su salud 6 restitucion de vida en alguno de su familia — y que va propagaudo el beneficio que lecibe, el consejo que ha oido, a fin de que sus convecinos se preparen y le imiten en la obra de profilaxis que el naismo realiza. Cuando por largo tiempo se explota la credulidad de las gentes para hacerlas vivir y morir en el error, como ha ocurrido con la anemia en Puerto Rico, dificilmente se logra devolverles la fe en aquellos mismos que le predicaron las falsas doctrinas acerca de su dolencia, si no se cuenta para ello con un poder de demostracion evidente y con un espiritu popular simpatico. Y aunque, es cierto que, para todo enfermo, el simple anuncio de posible curacion, abre las puertas a su esperanza y acepta gustoso cualquier sacrificio que se le imponga para lograr aquella, no es menos cierto, que tan desacre- ditadas estan en el feno de nuestra poblacion rural las medicaciones para curar la anemia, aconsejada^ por el medico, que solo a un espiritu de bondad popular que marche A parejas con el anhelo de hallar remedio a sus males puede atribuirse, en principio, la concurrencia del campesino a nuestros Dispensarios. Mas, como en esos Dispensarios encueutra la prueba inmediata de la verdad, y esa verdad le supone salud, vigor y bienestar liasta entonces no logrados y desde entonces obtenidos por virtud de un consejo y por obra de un medicamento, el concurrenle a esos centres sanando- de su enfermedad y aprendiendo los medios de que ha de valerse para, evitarla se apodera de las ideas que han de veneer el error en que ha vivido> desechando las viejas creencias de una tradicion utopica. Habla, pues, con la elocuencia de los numeros, ese movimiento de enfermos en nuestras Estaciones de tratamiento, de un malestar intenso que se siente en nuestros campos, de una demanda de remedio con ansias de curacion, y de una fe moribunda que despierta u la vida, con sus mejores energias, para devolverle a la Ciencia sus prestigios indiscutibles y a sus sacerdotes sus legitimes honores. Y cuando un pueblo reacciona en un orden de cosas determinado, como le ocurre al nuestro con la enfermedad que le enerva y que diezma a su poblacion rural, no le quedan mas que dos caminos, 6 ir derecho y de frente hacia el mal para exterminarlo donde quiera que lo encuentre, 6 replegarse a sus tiendas para morir, con las convulsiones horribles del que sabe que su padecimiento es curable, pero que su miseria no le permite la salvacion. Para lo primero, brinda su inteligencia clara, su voluutad decidida, su sencillez notoria, su docilidad manifiesta: para lo segundo, la resignacion humilde de su pobreza infinita. En la disyuntiva, nosotros no dudamos del camino que habra de seguirse, porque creemos a los hombres pensadores del pais, a los que se preocupan de los problemas economicos de la Isla, 34 ANEMIA EN PUERTO RICO. lo suficientemente penetrado.^ de la iinportancia y trascendeucia que este asunto entrana, i)ara que deje de merecerles ateuciou prefeiente. Pero, para facilitar la inarcha jwr ese camino, para evitar los obstaculos de una posible e(iuiv(x-ac-ion, seano.s ponnititidu hacer, a titulo de advertencia, algunas consi- deraciones acerca del servicio meilico municipal de la Isla, de la limitacion de los capitulos de Beneficennia eu las :Manicipalidades y de las escasas fuentes de recursos con que cuentan para aumentarlos, consideraciones que nos llevan a solicitar que osta obra iniciada por el Gobierno y por el patroci- nada,se continue por el misnio, en tanto que la calamidad persista, y mientras la necesidad de su existencia se justifique. Y es tanto mas necesaria esta aclaracion cuanto que, siendo la obra de que tratamos gestion medica y propia la enfermedad de 1()C'a necesidad de el, obteniendose solo con la expulsion de los panisitos la i)ionta dosajjaricion de los sintomas de uncinariasis y el aumento de hemoglobina eii la sangre. Dr. Felipe F. Vizcarrondo, Director de la Sxih-edaeion de Barranquitas. Seriore.-< de la i'omhU'm dr Aiieiiiin de Puerto Rico. Tengo el gusto do dar ouinpliiniouto a vuestras indicaciones en lo que a la presentacion de un brovo iiiforme, acerca do la uncinariasis en esta loca- lidad se refiere, manifostiiudolos : Que desde el 1" dc Agnsto I'lnpozo a funcionar, l)aio mi diroocion, en este pueblo una Subostacion para ol tratamiento y profilaxis di^ la uncinaria- sis, desde cuya fecha la Estaci»')n Central, en Aibonito, no ha dejado de man- darme todo lo necesario para combatir la enter medad. Es un hocho cierto y ovidonte que el Anquilostoma duodenal, en su variedad Uncinaria, se ceba on nucstro canq^esino, siendo esta la causa de la profunda anemia que patlece, mas (juo la alimentacion pobre y deficiente de su regimen. No es menos cierto que la mazamorra la adquieren casi todos los campesinos, al punto que do 1,255 casos solo cuatro negaron haberla patlecido, y se justifica por ol luibito do andar descalzos por sitios donde las evacuaciones do los enfermos ban poblado la tierra de larvas. Donde (piiora abundan ostas larvas porque, con mu\- raras excepciones, ol canq)osin() no tione letrina on sn casa y usa el monte para hacer sus descargas coiporales, bajo la sondira do los arbustos y en las siembras de los cafetos, y en ostas evacuaciones, que llevan los liuevos de los parasitos, se desarrollan los embriones que producon la mazamorra 6 que arrastrados por las aguas los ingiere el liombre. Dobo signiticarles que estoy sumamente satisfeclio con el tratamiento, ix)r que fie los 1,255 enfermos solo he {jerdido cinco y esos eran casos de fornias muy intensas y complicados con lesiones cardiacas etc. Tengo, adomas de esos 1,255 casos, setenta mas en tratamiento que no ban sido dasificados por falta de tienqjo y que iran en otra ocasion. Al Sefior Alcalde de esta numicipalidad Don Roberto Yives le soy deudor de gratitud por la ayuda valiosa que me ha prestado facilitando todo lo necesario para trasportar modicaniontos y dando ordenes para que cada m ANEMIA EN PUERTO RICO. 53 casa tenga su correspoiidiente letrina. Tal inedida se liace cumplir por la Policia y puede asegurarse que hoy uii cincuenta por cieuto la tienen. De Uds. atentaniente. (tRegorio Santo Domfxgo Gonzalez. Ojicial de Sanidad. P Barron, Euero 3, 1906. El que fH ANEMIA EN PUERTO RICO. INVERSION DE FONDOS. Sueldos $ 4,426.90 Medicanientos 2,086. 24 Valor (le los niedicamentos, S 2,086.24 Ga^tos (le tiasporte, 397.96 2,484.20 Proniedio de gasto por paciente, 13.11+cents. ManuteiK'ion, 9,994 raciones de enfernioi^ y empleados a 14.31-tceuts 1,430.51 Gastos de viaje de los Miembros de la Comi.^ion, Directores de las estaciones, etc 667.06 Tiasportes 646.00 Medicanientos 397.96 Hospital y efectos desde Utuado 6. Aibo- nito 193.57 Accesorios de Laboiatorio 4.85 Id. para la Cliniea 3.66 Miscelanea 45.96 646.0^ Instalacion, reparaciones, reuta de casa para empleados, etc... 520.23 Impresos y accesorios de oficina 307. 1 4 Renta de ua coche (incluyendo el cocliero) para el servicio en- tre Aibonito y el Hospital 267.00 Laboratorio 234.41 Instalacion, etc 30.68 Accesorios y aparatos 203.73 Trasporte 4.85 239.26 Instrumental para la Cliniea 141.52 Microscopios 91.00 Porta y cubre objetos y miscelanea 50.52 Trasporte 3.66 14508 Franqueo y Telegrafo 44.84 Miscelanea 36.92 8 10,808.77 Consignado por el Municipio de Aibonito para pago de ope- rarios en la instalacion 100.00 Costo total de seis meses de trabajo : S 10,908.77 Promedio de gasto por paciente 57.82-i-cents. . STATISTICS. I ESTADfSTICAS. I TABLE 1. CUADRO 1. TOTAL NUMBER OF PATIENTS CLASSIFIED ACCOKDIN(^ TO THEIR RESIDENCE. NUMERO TOTAL DE PACIKNTES AGRUPADOS SEGUN SU RESIDENCIA. CENTRAL STATION, AIBONITO. ESTACION CENTRAL, AIBONITO. Municipality of Aibonito: Municipalidad de Aibonito: Town of Aibonito mi Pueblo de Aibonito Barrio Robles 491 riata 565 Asomante 437 Caonillas 266 Cuyon 253 Pasto 252 " Algarrobo 206 Llano 396 Total 3.773 Municipality of Barranquitas: Municipalidad de Barranquitas: Town of Barranquitas 36 Pueblo de liarranquitas Barrio Barrancas 13 Caiiab6n 36 Helechal 105 Usabdn 23 Honduras 136 Palo hincado 100 " Quebrada grande 59 " Quebradillas 5-1 Total 5G2 Municipality of Barros: Municipalidad de Barros: Town of Barros 69 Pueblo de Barros Barrio Orocovis 40 Botijas 39 Damian arriba 5 Gate 19 Saltos 17 Bermejales 18 Damian abajo 5 Bauta arriba 24 Baiita abajo 8 Sabana 15 Barrio Cacaos 2 Pellejas 5 Barros 2 Mata de cafia 5 Total 273 Municipality of ComerIo: Municijialidad de Comerio: Town of Comerio 5 Pueblo de Comerio Barrio Palomas 21 Pinas 39 Rio hondo 28 Cejas 35 Vegas 30 Naranjo 8 Total 166 Municipality of Coamo: Municipalidad de Coamo: Town of Coamo 8 Pueblo de Coamo Barrio Pulguillas 397 " Jayales 48 Cuy6n 1 '• Palmarejo 16 '• Llanos 1 Pasto 2 " San Ildefonso 2 Santa Catalina 3 Coamo arrilja 10 Pedro Garcia 1 Total 489 Municipality of Cayey: Municipalidad de Cayey Town of Cayey 19 Pueblo de Cayey Barrio Toita 32 Pedro Avila 8 Pasto viejo 25 Piedra 6 ANEMIA IN PORTO RICO. Barrio Lapa 1 " Jacome alto 1 " Beatrlz 6 Maton arriba 3 Maton abajo 27 Quebrada arriba 3 Rincon 18 " Sumldo 2 '• Culebras abajo 3 Culebras alto 5 '• Monte llano 3 Farallon 1 Vega 21 Total 184 MlNICIPALITY OF CiDRA: Municipalidad de Cidra: Town of Cidra 53 Pueblo de Cidra Barrio Honduras -10 Rabanal 273 Toita 67 Bayamon 1 Saltos 71 Beatrix 1 Rio abajo 69 Sur 51 Ceiba 12 Monte llano 2 Rlnc6n 7 Arenas 3 Total 650 Mr.vK rPAi.iTY OF MoROVis: Municipalidad de Morovis: Town of Morovis 1 Pueblo de Morovis Barrio Perchas 1 Total 2 Municipality of Cagua.s: Municipalidad dc Caguas: Town of Caguas 4 Pueblo de Caguas Barrio San Salvador 1 Total 5 Ml'XICIPALITY OF Xaranjito: Municipalidad de Xaranjito: Town of Naranjito 1 Pueblo de Xaranjito Barrio Cedro abajo 1 " Cedro arriba 8 Total 10 Municipality of AcrAs Buenas: Municipalidad de Aguas Buenas: Barrio Juan Asencio 2 Bayamoncito 3 Sumidero 1 Total 6 Municipality of Salinas: Mu nicipcdidad de Salinas: Town of Salinas 2 Pueblo de Salinas Barrio Lapa 7 Aguirre 1 Total 10 Municipality of Corozal: Municipalidad de Corozal: Barrio Maria 4 Total 4 Municipality of Fajarh": Municipalidad de Fajardo: Town of Fajardo 1 Pueblo de Fajardo Total 1 MUNKIPALITV OF ClALKS: Municipalidad de dales Town of Ciales 1 Total 1 Municipality of Utuapo: Municipalidad de Utuado: Town of Utuado 1 Pueblo de Utuado i ayuy a l Total 2 Municipality of San ,Iuan: Municipalidad de San Juan: City 2 Ciudad Total 2 MUNKIPALITV OF Al!E( IHo: Municipalidad de Arecibo: Town of Arecibo 1 Pueblo de Arecibo Total 1 Municipality of Juana Diaz: Municipalidad de Juana Diaz: Town of Juana Diaz 3 Pueblo de Juana Diaz Barrio Caonilla arriba 2 Total 5 Municipality of Santa Isabf.l: Municipalidad de Santa Isabel: Town of Santa Isabel 6 Pueblo de Santa Isabel Total 6 Grand Total 6.152 ANEMIA IN POKTO RICO. SUBSTATION, BARRANQUITAS. MixiciPALiTY OF Bakraxqiitas: ^funicipolicla(^ de Barranquitas: Town of Barraii(|ultas ini Piirblo (!)• lUirnimntituis Barrio Palo h in cad o 339 Heleclial 275 ('anabon 177 " Honduras 41 Barrancas 96 Quebradillas I25 Quebrada grande i-io Total 1,294 Ml'XIClPALITY OF BaRROS: Municipalidad de linrros: Town of Barros 15 Pueblo de Hnrros Barrio Botijas oc Barrio Gato Bauta arriba. Total 116 MIXICIPALITY OF Naraxjito: Municipalidad de Naranjito: 2 Total. MrxiCIPALITY OF AlBOXITO: Municipalidnd de Aibonito: Barrio Robles Total 1 Municipality of Corozal: Municipalidad de Corozal: Barrio Palmarito 12 Total. 12 Graxi) Total 1.405 SUBSTATION, BAKROS. MixiciPALiTY OF Barros: Municipalidad de Barros: Town of Barro.s 271 Pueblo de Barros Barrio Cacaos 13 Col lores ■> Bauta abajo 50 Bauta arriba oj Damian abajo 41 Damian arriba 156 Bermejales 37 • Pellejas ..\^^'^'^^. 15 Saltos j.,^ Barros Gato Matadeeana Sabana Botijas IQg Orocovis -•) Total 1,1.59 MrXK IPALITV OF MoKOVI.s: Municipalidad de Morovis: Town of Morovis j Pueblo de Morovis 68 128 21 Barrio Pa.sto 37 Perchas 41 Total. MrxiCIPALITY OF ClALES: Municipalidad de dales: Barrio Pozas Total. MrxiCIPALITY OF Bayamox: Municipalidad de Bayambn: Barrio Catano Total. MrxiCIPALITY OK CoA.MO: Municipalidad de Coanio: Barrio Pedro Garcia Total . MUXICIPALITY OF COROZAL: Municipalidad de Corozal: Barrio Palmarito Total. MUXICIPALITY OF COA.MO: Municipalidad de Coamo: Town Of Coamo . . . . Pueblo de Coamo Barrio Pasto. Graxd Total 1.2,55 SUBSTATION. COAMO. 206 Palmarejo 3^5 Pulguillas ' 00 Jayales g6 Coamo arriba 140 Pedro Garcia 173 Santa Catalina 1.31 Llanos gg Cuyon 4 San Ildefonso 22 Total 1,040 ANEMIA IN PORTO RICO. Municipality of Santa Isabel: Municipalidad de Santa Isabel: Total Municipality of Juana Diaz; Municipalidad de Juana Diaz: Total Municipality of Barranquitas: Mitn ieipalidad do Barranquitas: Total Municipality of Ponce: Municipalidad de Ponce: 1 Total 1 Municipality of Barros: Municipalidad de Barros: 2 Total 2 Grand Totai 1,018 SUBSTATION, COMERIO. Municipality of (:omerio: Municipalidad de Comerio: Town of Comerio Pueblo de Comerio: Barrio Pinas Palomas Rio hondo Doiia Elena Cedrito Naranjo Cejas Vega H27 122 190 20:5 228 94 93 83 l:« Total 1.478 Municipality of Bay-amon: Municipalidad de Baijambn : Barrio Nuevo ■' Guaragiiao Dajaos Total. Municipality of Barranquitas: Municipalidad de Barranquitas: Barrio Quebrada grande •• Quebradillas Total. Municipality of N'aran.iito: Municipalidad de NarI!a: Municipalidad de Cidra: Barrio Ceiba Rabanal Cerro gonlo. . . Monte llano. . . Rio abajo Total Municipality of A(;uas Buenas: Municipalidad de Aguas Buenas: Town of Aguas Buenas Pueblo de Aguas Buenas: Barrio Mulitas Juan Asencio Bavamoncito Total . (iRANI) total 1,676 SUBSTATION. GUAYAMA. Municipality of Guayama: Municipalidad de Guayama: Town of Guayama 286 Pueblo de Guayama: Barrio GuamanI " Palmas " Caimital Carmen Caribe Pozo hondo Corazon Algarrobo Jobos Mareas Dureiio Machete 116 52 44 32 24 14 22 1 19 Total. 623 Municipality of Cayev: Municipalidad de Cayey: Town of Cayey Pueblo de Cayey: Barrio Jacome bajo... Total Municipality of San Lorenzo: Municipalidad de San Lorenzo: Town of San Lorenzo Pueblo de San Lorenzo: Barrio Quebrada Arenas Total . ANEMIA IN PORTO RICO. MiNiciPAi.iTY OF Path. I. AS. MunicipalkUtd de Patillux: Town of Patillas Pueblo de Patillas. Barrio Mamey grande Real '• Mamey chlco Mat6n Apeadero Cacaos Riachuelo Barrio Lapa , Total. Total 104 MiNiciPAUTY OF Salinas: Municipnlidad de Salinas: Barrio Aguirre MfNICIPALITY OF ArEOYO: Munieipalidad de Arroyo: Town of Arroyo Pueblo de Arroyo. Barrio YaurC'l Pita Haya Cuatro Calles Faro Total Grand total 746 SUBSTATION, SAN SEBASTIAN. MfNKIPALITY OF SaN SEBASTIAN: Munieipalidad de San Sebastian: Town of San Sebastian Pueblo de San Sebastian. Barrio Bahomamey Guatemala Hato arriba Pozas Sonador Alto.sano 'iiiaeio Cnlebriiias Calaba/a.s 28 36 88 18 7 7 6 8 13 Barrio Mirabeles Perchas Juneal Enea Magos C'ldral Piedras blancas. Hoya mala Guajataca Albonito " Robles Salto 1 34 20 15 34 81 38 47 75 62 40 Total 663 Grand total. .Mink ipALiTY of Moca: .^tunicipulidad de Moca: Town of -Moca Pueblo de Moea. Barrio Maria Cruz SUBSTATION. MOCA. Barrio Voladoras... Capa Cucbilla ■' Cerrogordo. Plata 663 Total. Grand total. -MtNiciPAHTY OF Utiado: Munieipalidad de Utuado: SUBSTATION. UTUADO. 80 Town of Utuado Pueblo de Utuado. Jayuya J03 Barrio Rio abajo I05 Las Palmas 7 Mameyes 227 Vlvi arriba 83 Don Alonzo II9 Caguana 154 Tetuan . Sabanagrande 53 Roncador rr Barrio Arenas " Vivi abajo. . Caonillas Salto abajo. . " Consejo Salto arriba. Paso Palma. Santa Hosa.. Guaonico " Angeles " Canlaco Limon 67 62 71 70 .54 72 49 42 55 14 23 36 Total 1.652 I ANEMIA IN PORTO RICO. Vll Municipality of Arecibo: Municipalidad de Arecibo: Barrio Carrera 28 " Tanamd 11 Rio arriba 12 Hatoviejo 13 Total &i Ml'NICIPALITY OF HATILLO: Municipalidad de Hatillo: Town of Hatillo 2 Pueblo de Hatillo. Barrio Naranjito 3 Total 5 Municipality of Ciales: Municipalidad de Ciales: Town of Ciales 9 Pueblo de Ciales. Total 9 SUBSTATION, Municipality of Lakes: Municipalidad de Lares: . ... .314 Pueblo de Lares. Barrio Poblacion . . . . 161 " Bartolo . . . . 247 " Buenos Aires . . . . .537 Callejones 1.52 Espino . . . . 326 Lares . . . . 586 Latorre . . . . 231 Mirasol . . . . 1.36 " Pezuela 67 Piletas . . . 30.5 " Rio prieto 95 Total.... ... 3.4.57 Municipality of San Sebastian: Municijialidad de Sail Sebastian: Barrio Magos Enea " Juncal " Perctias " Mirabeles Total. Municipality of Las Marias: Municipcdidad de Las Marias: Barrio Cerrote " Espino Total. Municipality of Adjuntas: Municipalidad de Adjuntas: Town of Adjuntas 27 Pueblo de Adjuntas. Barrio Portillo 1 Pellejas 44 •' Capaes 8 " . Vega arriba 3 " Yahuecas 2 " Yayales 1 Total 81 Municipality of Ponce: Municipalidad de Ponce. City of Ponce 1 Ciudad de Ponce: Barrio Guaraguaos 1 Total 2 Grand Total 1,813 LARES. Municipality of Ca.muy: Municipalidad de Camuy: Barrio Cienaga 2 " Quebrada 1 " Cibao 3 Total 6 Municipality of Utuado: Municipalidad de Utuado: Barrio Angeles 373 Santa Isabela 28 Caguana 3 Total 404 Municipality of Adjuntas: Municipalidad de Adjuntas: Barrio Portillo 10 Yahuecas 3 Total 13 Municipality of Hatillo: Municipalidad de Hatillo: Barrio Bayaney 21 Aibonito 1 Total 22 Municipality of Arecibo: Miinicipalidad de Arecibo: Barrio Esperanza 2 2 Grand Total 4,001 ANEMIA IN POKTO RICO. TABLE 2. NUMBER OF VISITS TO THE DISPENSARY AT THK CKNTHAL STATION, AIBONITO, GIVING RESIDENCE OF THE PATIENTS. FROM: NUMBER Xihneyu) dr De: : 1 2 3 4 5 6 7 MrN'UIPALTTY OF AlBOXITO: Miinicipnlidnd dr Aibnnilo: Alltotilto. Town 1 245 73 105 ; 37 i 17 45 49 28 75 157 53 71 47 26 48 38 32 48 141 51 121 66 48 35 27 34 67 101 87 56 74 45 35 48 24 32 40 61 79 54 44 26 26 26 55 46 48 43 40 21 16 8 15 a5 35 31 27 37 20 8 13 11 18 Aihiinild, Pueblo. Barrio Robles ... Plata f'aonlllas ('iiy6n Pa.sto I.lauo Total 674 5-20 590 505 423 272 200 .MiNICII'Al.ITY OF B.\KKAXQI'ITAS: Miniiripdiidad de Barranquitas: Barranquitas. Town lifirraiirjtiitns, Pueblo Barrio, Barrancas Canabon Helechal Honduras Palo hineado Quebrada Krande Q\iebradlllas Usabon Total. MtXICIPALlTY OF BaURCS: Muniripalidad de Rnrros: liarros. Town Harrog, Pueblo. Barrio, Orooovis Botijas Danilan arriba. .. (iato Saltos Bermejales Damlan abajo Baiita arriba Bauta abajo Sabana Caeaos Pellejas Barros Mata de cana Total. 7 3 6 4 4 1 3 1 5 1 2 2| 7 7 4 9 2 2 !■ 11 9 15 19 16 10 9; 27 13 28 20 19 9 7! 18 16 12 15 12 11 7 1 12 10 8 12 3 3 1 19 8 6 5 3 3 6 5 5 3 1 1 1 108 71 89 87 61 42 31 18 9 9 8 5 4 5' 9 5 5 4 3 6 2' 11 3 5 4 10 1 21 1 2 1 if 6 6 3 1 1 '< 3 1 4 4 1 1 1 3 2 2 3 1 2 2 1 1 5 3 3 2 4 2 1 1 1 1 2 2 3 2 1 2 1 1 1 1 1 1 1 1 1 1 3 2 64 36 39 29 33 17 14 ANEMIA IN PORTO RICO. OUADRO 2. NUMERO DE VISITAS AL DISPENSARIO DE LA ESTACION CENTRAL, EN AIBONITO, SEGUN LA RESIDENCIA DE LOS PACIENTES. CRSONS WHO HAVE MADE rHE NUMBER OF VISITS INDICATED. rsonas que h an hecho el niimero tie visitas inclicnflo. 8 9 10 11 12 13 14 15 , 16 17 18 Hospital. * Total. 38 27 20 10 5 3 5 6 2 2 5 907 29 16 12 11 8 3 1 1 .. 3 491 22 12 10 8 1 2 3 1 ■• 4 565 31 15 4 10 8 3 2 •■ 8 437 11 13 4 4 6 2 3 .. 1 266 8 10 4 5 5 1 7 253 18 10 7 4 1 2 252 11 5 6 4 2 1 5 206 19 6 16 5 6 2 M 10 396 .87 111 83 57 45 16 13 14 11 2 4 1 43 3,773 3,773 2 4 1 .. 1 1 3 1 3 4 3 3 1 1 5 2 2 2 3 3 1 3 3 1 2 1 1 1 .. 16 16 13 8 3 1 I 1 36 13 36 1 105 2 136 2 100 1 59 8 54 23 15 562 562 3 1 1 " 6 69 1 1 1 3 40 1 1 1 1 1 1 3 3 39 5 19 17 18 1 ' • 1 5 4 2 5 24 8 15 2 5 2 5 6 3 2 2 .. ^ 28 273 273 ANEMIA IN PORTO RICO. FROM : Pe: Mink iPAi.iTV of comekio; Mitniripalidfid de Cotnerfo: lomerlo. Town Ojinftio. Pueblo. Barrio. Palomas Pinas Kio hondo fejas Vega " Naranjo Total. I 20 MiNirii'.Ai.iTY OF CoAMo: Miinicipalidad de Coainu: Coamo. Town Coan\(), Pueblo. Barrio. Pulgiiillas Jayales Palmarejo ('uy6n '■ Llanos Pasto San Ildefonso.. .■^anta Catalina., Coamo arriba.. Pedro (Jaroia... MrsiciPAi.iTY OF C'ayey: Municipalidad de Cayey: C'ayey. Town (^iff<'y> Pueblo. Barrio. Tolta Pedro Avila Pasto vlejo Pledras Farall6n Lapa Jacome alto Culebras abajo. . Culebra-s alto Monte llano Vega Heatriz Maton arriba Maton abajo Qiiebrada arriba. Rincun S\inildo MtNKIPALITY OF CiDRA: Municipalidad de Cidra: Cldra. Town Cidra, Pueblo Total. Total. 35 i 4 v., 1 1 3 3 1 ' 10 1 ^ 2 5 2 i 1 1 5 1 8 1 3 ■ 2 4 1 1 1 6 1 6 1 3 1 2 5 2 7 1 1 1 1 2 5 3 2 3 1 1 4 5 1 3 2 1 2 ■• "2 1 2 2 2 1 3 1 3 1 1 2 3 1 •• 44 14 27 12 36 8 2.5 5 11 4 9 ANEMIA IN PORTO RICO. KSOXS WHO HAVE MADE THE NUMBER OF VISITS INDICATED. •sonas que han hecho vl nionero de visitos indicado. ( 9 10 11 12 13 14 15 16 : 17 ! 18 Hospital. Total. 1 4 3 1 2 1 1 2 1 1 2 1 5 21 39 28 35 30 8 9 ■^ 3 1 1 -1 166 166 3 1 8 11 1 397 48 16 1 1 2 2 1 3 10 ' 1 15 480 489 184 1 xii ANEMIA IN PORTO RICO. Harrlo. Kabaual ... Honduras. Tolta Salto Ueatrlz Rloabajo., " Siir FROM : De: Ceiba Monte llano. Rinc6n Arenas Bayam6n Total. NUMBER ( J^umero d 1 2 3 4 5 6 7 24 35 67 59 29 20 1 3 9 10 5 8 1 6 7 13 15 18 4 13 14 15 9 1 8 8 5 11 16 14 10 5 11 3 9 15 5 2 2 2 5 2 1 2 1 2 1 1 ,, 1 1 1 81 93 143 129 86 40 2 MrSUIPALITY OF MOEOVIS: ^funicipaU(^ad tie Morovis: Morovis, Town Morovis, Pueblo Barrio Perchas Total. Municipality of Caguas: Munieipalidad de Cuguas: Caguas, Town Caguas, Pueblo Barrio, San Salvador Total. Municipality of Naranjito: Munieipalidad de Xara/ijito: Naranjito, Town Naranjito, Pueblo Barrio, Cedro abajo Cedro arriba Total, 1 1 1 2 6 .. ' * 1 3 6 .. Municipality of Aguas Buenas: Munieipalidad de Aguas Buenas: Barrio, Juan Asencio Bayamoncito Sumidero 1 1 1 2 1 Municipality of Salinas: Munieipalidad de Salinas: Salinas, Town Salinas, Pueblo Barrio, Lapa Agulrre Total, 2 3 2 1.. 1 3 4 11 } ANEMIA IN PORTO RICO. xiii ■ERSONS WHO HAVE MADE THE NUMBER OF VISITS INDICATED. )ersonas que han hecho el numero de visitas indicadn. 8 1 9 1 10 1 11 12 13 14 15 16 17 18 Hospital. Total. \ 1 2 1 1 1 14 2 2 1 j .. . ' 1 1 ' 1 • 17 1 ■i 1 273 40 67 71 1 69 51 12 2 7 3 1 4 1 -A 1 32 6.50 650 1 1 1 1 2 2 2 4 1 1 3 5 5 1 1 8 .. 10 10 2 1 7 .. 1 .. 1 1 .. 10 10 ANEMIA IN PORTO RICO. FROM : NUMBER ( ^'iimero d De: 1 2 3 4 5 6 7 Ml'NKIPALITY OF COROZAL : ^rlnliciptllida(l de Corozal: 3 1 1 1 .. Ml NKirAi-iTY OK Utuauo: Mnuiripulidinl de Uluado: \ I'tuadoy Pueblo Total 1 1 MiNKirAi.iTY OF San Jian: yfiiniripnlidnd de San Juan: San J nan, fity San Juan. Ciudad. Mink ii'ality of Akecibo: Muiiicipdlidad de Arecibn: Areclbo, City Arecibo, Ciudad. MlNICIPALITY OF JlANA DiAZ: Municipalidad de Juana Diaz: Juana Diaz, Town JiKtiiii Diaz, Pueblo. Barrio, Caonillas arriba Total. 1 1 1 .. 1 .. 1 1 1 MlNICIl'ALITY OF FaJAKDO: Municipalidad de Fajardo; Fajardo, Town Fajardo, Pueblo. Municipality of Ciales: Municipalidad de Ciales: Ciales, Town Ciales, Pueblo. Municipality of Santa Isabel: Municipalidad de Santa Isabel: Santa Isabel, Town Sanla Isabel, Pueblo. 1 1 G * Hospital Patients were considered as making one visit to the clinic on the date admitted, as they were examined at the clinic before admission. This column shows those who remained in the hospital until cured and are considered as making but one visit. Other hospital patients are included elsewhere according to the number of visits made after discharge from the hospital. I w ANEMIA IN PORTO RICO. ERSONS WHO HAVE MADE THE NUMBER OF VISITS INDICATED. >.rsonas que hnn hecho el nianero de visitas indicado. 8 9 10 11 12 13 14 15 16 17 18 Hospital. Total. .. 4 1 1 1 2 2 1 1 3 2 2 5 5 6,152 * Los pacientes del hospital fueron considerados como visitantes de una vez d la clinica, pues ! ella se les ezamiuaba antes de su adrnision. En esta columna se incluyen aqueUos que perma- '.cieron en el hospital hasta su curacibn y que fueron considerados como visitantes de una sola z. A otros pacientes del hospital se les incluye en otro sitio de acuerdo con el numeru de visitas •chas despues de haber salido de aquel. XVI ANEMIA IN PORTO RICO. TABLE 3* GUADK OF UNCINARIASIS AND RESIDENCE OF PATIENTS, Central Station, Aibonito, CUADRO 3* FORMA DE LA UNCINARIASIS Y RESIDENCIA DE LOS PACIENTES. Estaci6n Central, Aibonito. GRADE. Forma. RESIDENCE. ^ . ^ Re»i(lencia. ^ Cl a s he S J=5 II II i i a c^ "5 Town ok Aibonito: Pueblo de Aibonito: First thousand Primer miliar Second thousand.. Segiiiidii miliar Third thousand.... Tercir miliar Fourth thousand.. Cuarto miliar Fifth thousand Quinto miliar Sixth thousand Sexto miliar Seventh thousand. Septimo miliar Total. BARRIOS : RoBLES : First thousand Second thousand.. Third thousand.... Fourth thousand.. Fifth thousand Sixth thousand Seventh thousand. Total. PI..KTA : First thousand Second thousand ... Third thousand Fourth thousand Fifth thousand Sixth thousand Seventh thousand.. MUNICIPALITY OF AIBONITO. Municipalidad de Aibonito. 45 6 2 9 1 1 1 -' 9 2 1 8 4 1 .5 1 326 122 111 91 14.3 102 12 2 111 3 116 3 53 1 65 3 80 63 ■' 12 491 491 Total. 8 21 26 19 1 1 76 19 32 24 15 9 92 9 23 18 7 1 5 63 8 51 29 10 1 4 103 11 41 32 8 1 4 97 12 5-1 41 9 1 5 4 125 5 3 1 9 1 67 222 175 n i 9 21 565 565 ANEMIA IN PORTO RICO. xvii <3r^lAJr>TS.. Forma. RESIDENCE. liesidencia. e s s 3 a; II a) ^ i i a s 5 o ASOMANTE : First thousand 11 12 25 14 1 63 Primer miliar Second thousand 8 25 20 8 3 64 Segundo miliar Third thousand Tercer miliar 1 ^^ 31 20 8 1 1 5 76 Fourth thousand Cuarto miliar 6 55 27 8 2 2 100 Fifth thousand Quinto miliar 13 29 25 8 2 2 79 Sixth thousand Sexto miliar 4 21 14 8 1 1 49 Seventh thousand Septimo miliar 4 2 6 Total 53 173 135 56 "l 13 437 437 Caonillas: First thousand Second thousand . . Third thousand.. . Fourth thousand.. Fifth thousand Sixth thousand. .. Seventh thousand. Total. 10 9 26 10 1 56 7 21 12 5 4 49 3 17 11 1 1 33 1 21 10 4 1 2 39 8 30 9 3 1 2 53 4 15 11 2 1 33 2 1 3 33 113 81 26 4 9 266 266 Cuy6n : First thousand Second thousand.. Third thousand Fourth thousand.. Fifth thousand Sixth thousand Seventh thousand. Total. 15 9 16 13 1 1 55 6 20 20 6 5 57 4 14 13 3 2 2 38 4 17 11 6 38 2 8 9 2 21 5 19 8 4 2 1 39 4 1 5 ;l 36 87 81 35 5 9 253 Pasto : First thousand Second thousand.. Third thousand Fourth thousand... Fifth thousand Sixth thousand Seventh thousand. Total. 10 16 4 19 3 17 2 15 3 24 9 9 31 100 86 59 38 2 31 1 34 3 55 9 30 5 8 252 ANEMIA IN PORTO RICO. G-RADE. Forma. KKSIUK.NCE. /{fniilfiicio. Very light. Muy benigna. 6 S Si "Z 3 sq il i i i i il o Al.ciARKOBO: \ 12 11 1 2:j 18 7 4 •J 2 1 1 2 2 3 2 1 55 53 30 83 23 12 I'riiinr tiiiUar 24 12 15 ; 12 ,Si'(/ 11 11(1(1 miliar Tcrccr miliar 24 4 5 4 CiKtrto miliar Fifth thonsaiiil 1 ! 10 Qiiiiitd miliar Sixth thousau'l 7 Serto miliar Seventh thousand Sf'plimo miliar ! 1 Total 26 103 50 16 5 6 206 206 Llano: First thousand Second thousand Third thousand Fourth thousand Fifth thousand Sixth thousand Seventh thousand... Total . 8 12 22 13 1 56 10 26 19 10 2 1 68 7 24 17 5 1 6 60 3 22 23 11 1 60 6 29 25 9 1 3 73 10 35 22 5 1 73 3 1 6 44 150 131 54 6 11 396 396 MUNICIPALITY OF BARRANQUITAS. Municipalidad de Bclrranquitas. Town of Bakranquitas; I'lieblo lie Barranquitas First thousand Second thousand Third thousand Sixth thousand Seventh thousand Total.. 2 3 5 1 11 1 5 5 2 13 4 4 2 10 1 1 1 1 3 12 15 3 1 2 36 36 BARRIOS: Harranca.s : First thousand Second thousand... Third thousand Fourth thousand Total 1 1 1 1 3 5 3 3 6 1 ' 1 1 4 4 4 13 13 ANEMIA IN PORTO RI( :o. XIX Forma. RESIDEN'CE. Residencia. 8 ^ Si J3 S 6c J 3 =c . e II •a ■? 14 II 5^ 6 2 e . IS CO 00 o Canab6n: First thousand 1 3 2 2 1 4 5 3 1 2 2 1 1 1 . 5 5 15 9 1 1 Primer milUtr. Segundo miliar. Terccr miliar. Cuarto miliar. Fifth thousand (Juinto Millar. Sixth thousand Sexto miliar. Total i 1 12 12 10 1 36 36 HEi.ErHAl.: First thousand Second thousand.. Third thousand Fourth thousand.. Fifth thousand Sixth thousand Seventh thousand. Total. •iABoX: First thousand Third thousand Fourth thousand Sixth thousand Seventh thousand . . . Total. Honduras: First thousand Second thousand Third thousand Fourth thousand Fifth thousand Sixth thousand Seventh thousand... Total Palo hincado: First thousand Second thousand. Third thousand.. Fourth thousand. Fifth thousand.. . Sixth thousand.. -' 1 3 4 10 1 7 6 8 1 23 5 14 10 1 :30 3 8 2 13 3 10 b 18 1 3 2 2 8 1 1 1 •^ 12 39 .3.-) 17 2 105 105 1 1 3 1 5 2 3 1 2 1 1 2 8 10 Total. B 4 9 3 4 23 23 136 136 2 4 1 8 6 10 7 25 15 15 5 2 40 6 4 5 1 1 18 4 1 6 1 2 3 32 34 21 4 1 100 100 ANEMIA IN PORTO RICO. MUXICIPALITY OF BARROS. Mitiiicipalidad de Barros: 'i'liWN OK Bakkos: J'lirhlo ttr Barros: First thousand Second thousand... Third thousand Fourth thousand Fifth thousand Sixth thousand Total BARRIOS: Okocovis: First thousand Second thousand Third thousand Fourth thousand Fifth thousand Total &RA3DE. Forma. RESIDENCE. Resideiicia. e s Si ':: II Light. Bcnigna. . 8 ii i i a s 2l i i a s a 1 to c 3 QlEBRADA CiRANDE: 3 3 6 Primer miliar. Second thousand Scgundo miliar. 1 5 5 1 12 Third thousand 2 4 3 6 1 16 Tercer miliar. Fourth thousand Cuartn miliar. 2 2 1 5 Fifth thousand Quinto miliar. 1 3 4 Sixth thousand 4 8 2 14 Her to miliar. Seventh thousand Septimo miliar. 1 1 2 Total I 20 24 9 1 1 1 59 59 QtEBItADII.LAS: First thousand 1 1 2 2 1 3 2 4 8 Second thousand Thinl thousand 2 9 •3 7 8 24 Fourth thousand 1 4 2 1 8 Fifth thousand 2 3 2 1 8 Sixth tliousand 1 1 2 Total 2 13 12 1.5 5 7 W 54 5 1 5 5 16 2 8 6 2 1 19 2 7 3 2 1 1 16 2 4 2 1 9 3 2 5 1 1 1 1 4 10 22 21 12 2 2 69 69 1 1 7 2 11 1 5 2 2 10 2 2 4 5 6 2 13 1 1 2 5 13 1 7 40 40 ANEMIA IN PORTO RICO. RESIDENCE. Residencia. Forma. ^^ BOTIJAS : First thousand Primer miliar Second thousand . . . Sec/ undo miliar Third thousand Tererr miliar Fourth thousand . . . Cuarlo miliar Fifth thousand Quinlo miliar Sixth thousand Sexto miliar Seventh thousand . . Septimo miliar Total DaMIAN ARRIBA : First thousand Second thousand Fourth thousand Total Gato: First thousand Second thousand... Third thousand Fourth thousand . . . Sixth thousand Total Saltos: First thousand Second thousand Third thousand Fifth thousand Sixth thousand Seventh thousand.. Total Bermejales: Second thousand Third thousand Fourth thousand Fifth thousand Total Damian abajo: Second thousand Third thousand Fifth thousand Total 3 a; e g s ^ a s S. .1 > ^ 1 2 1 1 1 1 1 3 1 1 3 i 5 .5 2 2 1 1 2 1 5 1 1 8 3 1 6 1 1 1 1 10 3 4 1 1 10 ^ 2 1 1 1 :j 2 3 5 2 1 2 5 1 1 1 1 1 8 4 1 17 17 1 2 1 4 1 2 2 1 6 4 1 2 1 3 2 8 4 4 18 18 1 1 2 1 1 2 1 1 2 2 1 5 5 xxii RESIDENCE. ResUlcncia. Total. Baita abajo: Sepoml tbonsand.. Fourth thousand.. Sixth thousand • Seventh thousand. Total Sabana: .* Forma. 3«5 I 1 ! ! 1 > ^ XJ ff; 2 1 1 ' 1 1 1 1 2 1 ■1 1 1 1 2 3 1 4 1 1 1 3 1 1 2 2 2 4 1 7 8 3 1 lo . 1.5 1 1 j 1 1 1 1 1 2 2 1 1 1 1 1 2 i ° 1 i 1 1 1 b 1 1 1 1 ! 2 2 2 ANEMIA IN PORTO RICO. xxiii &Rj^J3E Forma. RESIDENCE. ^ 1 Bcsidencia. ^ Sl -a e "S ? s a i ^ i S 2 2 =>; 3 8 II 2^ Town of Comerio: Pueblo de Comerio: First thousand Primer miliar. Second thousand See/undo miliar. Third thousand Tercer miliar. Total, BARRIOS: Palomas: First thousand Second thousan d Third thousand Fourth thousand Sixth thousand Total, PiSas: First thousand Second thousand Third thousand Fourth thousand Fifth thousand Sixth thousand Total, Rio Hondo: Second thousand Third thousand Fourth thousand Seventh thousand.. Total Cejas. Second thousand Third thousand Fourth thousand Fifth thousand Sixth thousand Total MUNICIPALITY OF COMERIO. Municipalidad de Comerio. 1 1 1 1 2 1 3 2 2 1 5 5 1 1 1 1 3 1 6 2 1 10 3 2 1 6 1 1 \ 1 1 6 9 4 2 21 21 1 5 6 1 2 4 2 9 1 2 3 2 2 1 3 4 6 5 4 15 1 10 15 11 2 39 39 5 7 1 4 2 9 8 1 1 15 1 1 2 2 2 12 5 3 1 28 28 2 1 9 10 1 2 1 1 2 1 11 14 3 22 1 4 2 4 1 35 xxiv ANEMIA IN PORTO RICO. KESIDENCE. Jiesidcncia. VE(;a: Second thousand Segunilo miliar. Third thousand Tcrrrr )uilliir. Fifth Ihoiisiiiid Qui II In miliar. Sixth thousand Nerlii miliar. Seventh thousand . . Sfpliiiio miliar. Total Naiian.ki: Third thousand Sixth thousand Total s = Forma. a s > ^ e . -e ■V e aj u s s o H 1 6 13 ' 6 4 1 1 3 ^1 1 7 1 1 1 1 3 1 3 1 8 1 8 MUNICIPALITY OF COAMO. Municipalidad de Coamo. Town ok Coamo: I'ui'blo de Coamo. Second thousand... Third thousand Fourth thousand Fifth thousand Sixth thousand Total BARRIOS: I'ri.r.fii.i.As: First thousand Second thotisand... Third thousand Fourth thousand Fifth thousand Sixth thousand Seventh thousand.. Total .1 VYAI.ES: Third thousand Fourth thousand Fifth thousand Sixth thousand Seventh thousand.. Total 1 5 2 8 34 21 6 1 71 11 29 16 6 1 4 70 1 49 23 7 1 86 10 19 20 7 3 89 8 36 20 8 9 69 : 1 3 4 i 11' 197 108 36 5 9 397 397 4 1 1 2 8 6 6 1 13 1 8 4 13 1 6 2 3 12 2 2 2 1 26 1 13 4 1 2 48 48 ANEMIA IN PORTO RICO. XXV GrTlAJDlS. Forma. RESIDENCE. Residencia. ^ & a s e fr S 5 ■ c Ol 5i « s *; s S OJ S a s Ol 00 b5= > ^ is s 3 05 .2 -S H5 > ^ S 5 t3 '5 5 o Cuyon: Third thousand 1 1 Terccr miliar. Total 1 1 1 Palmarejo: Third thousand Fourth thousand Fifth thousand Sixth thousand Total. LLANO.'i: Third thousand Total. Pasto: Third thousand Total. San Ii.dekonso: Third thousand Total. Santa Catalina: Third thousand Total. COAMO ARRIBA: Fourth thousand Fifth thousand Sixth thousand Seventh thousand . . . Total. Pedro (jarcia: Sixth thousand Total. 1 1 2 2 1 6 2 1 3 3 2 • 5 8 6 2 16 1 . 1 ' 1 1 2 1 t 1 1 2 1 2 2 2 2 2 2 3 3 3 3 3 3 3 1 1 1 3 1 1 2 1 1 2 1 4 2 2 1 10 1 1 1 1 1 MUNICIPALITY OF CAYEY. Municipalklad de Cayey: Town of Cayey : Pueblo de Cayey: Third thousand Fourth thousand . . . . Fifth thousand Sixth thousand Seventh thousand.. Total 1 1 2 2 4 1 1 2 4 2 1 7 1 2 2 5 4 9 5 1 19 19 ANKMIA IN PORTO RICO. Forma. RESIDENCE. Henidenciii. «s KARRIOS: Ti>lT.\ : .'^epond thousand.'.,. Segnndo tnillnr Fourth thousand f'linrtii miliar Kiflh thousand (jiiiiilit iiiilhir .-^Ixth thou>and Sfjrio iiiilliir Seventh thousand.. Sfpliino miliar Total l'Kl>i;n .\vii..^ : Third thousand Kourlh thousand... .Seventh thousand.. Total l'.V.>'Tll VIKJIt : Third thousand Fourth thousand Fifth thousand Sixth thousand .Seventh thousand . . Total I'iKi>i:.\ : Third thousand Fourth thousand Sixth thousand Total I,Ai-.\ : Fourth thotisaud... Total .J.Vdi.MK .\l,TO: Fourth thou.-^and Total Mk.vtriz; First thousand Second thousand... Total 5 ^ 1^ S '" ii 2^ Intense. Intensa. Very int Muy int I 11 51 1 1 1 1 3 1 8 2 1 6 2 5 2 1 1 9 1 :2 1 3 1 1 1 1 2 4 6 « 1 1 1 1 I 2 5 « 8 2 2 2 1 1 4 3 5 2 1 11 1 2 1 3 7 1 1 1 7 10 ') 1 1 2-5 2.i 1 1 1 2 1 1 1 3 1 1 1 1 1 6 6 i 1 [ 1 1 1 i 1 1 j 1 - 1 4 2 2 2 3 6 6 \NK31 lA IN FOU'J 'O KiC o. XXVll GRADE. Forma. RESIDENCE. jResidencia. 1 8 S > ^ be £ 2 aq 5 S a ? i i a ?: a s > ^ i i 5 o MaTON ARRIBA : First thousand 1 1 /'rimer miliar. Third thousand [ 2 2 Trrrrr xiillar. 1 Total I 3 3 3 Matox abajo: ! Second thousand 1 1 1 1 3 12 2 1 1 3 1 1 1 2 3 19 2 Fourth thousand j Fifth thousand Sixth thousand Seventh thousand Total 2 5 14 5 1 27 27 QtEBRADA ARRIBA: 1 1 1 1 Seventh thousand Total 1 1 I 1 3 3 Rincon: 1 1 Second thousand 1 1 3 1 1 2 1 1 1 ; 2 [ 3 1 1 1 ^ 1 2 5 2 4 4 Third thousand Fifth thousand Sixth thousand Seventh thousand Total 5 5 6 2 ; 18 18 Sum I do: Seventh thousand Total 1 1 2 1 1 : 2 2 CULEBRAS ABAJO: Fifth thousand 1 ! 1 Sixth thousand 1 1 1 i Total 1 1 1 1 1 3 1 3 Culebkas ai.to: 1 Fourth thousand 1 1 1 ^ -' Fifth thousand 1 1 (J 1 1 1 ■ 1 1 1 Sixth thousand Seventh thousand Total •_) 2 1 5 5 Monte llano: Fourth thousand Total 2 1 U I 3 2 1 1 1 3 3 \ \ viii ANEMIA IN PORTO IIICO. Forma. RESIDENCE. Jiixiilfiuia. Very light. Muy benigna. c s II II It 2^ 6 e c s > ^ .1 il H FARAI.I.O.N: \ ° 1 1 Cuurlir milliir Total 1 1 1 Veua: Sixth thou.sand Seventh thousand... Total. Tows OK Cihra: Pueblo tie Ciitra: First thousand Second thousand. Third thousand.... Fourth thousand.. Fifth thousand Sixth thousand Seventh thousand. Total. BARRIOS: HONDVRAS: Third thousand... Fourth thousand. Fifth thousand... Sixth thousand... Total. RabanAl: First thousand Second thousand Third thousand Fourth thousand Fifth thousand ... Sixth thousand Seventh thousand... Total. Toita: First thousand Second thousand Third thousand Fourth thousand Fifth thousand Sixth thousand Seventh thousand... 1 6 ■ 2 3 12 6 2 1 9 1 12 4 ^ i 21 21 MUNICIPALITY Municipalidacl OF de CIDRA. Cidra. 1 1 1 3 3 1 8 1 3 1 2 2 9 1 3 3 1 . 8 1 2 2 1 3 12 3 2 4 1 3 13 1 1 2 9 11 15 8 10 53 53 1 1 4 2 8 3 1 1 1 6 2 2 3 7 9 5 24 4 11 16 8 1 40 40 2 2 1 8 1 10 1 4 8 10 4 1 1 28 35 33 11 1 85 26 22 8 1 57 8 29 30 8 75 13 3 16 17 99 118 35 1 3 273 Total. 1 1 2 1 2 4 1 7 1 7 6 20 1 1 5 13 18 28 1 67 1 67 ANEMIA IN PORTO RICO. xxix &RA.I3E. Forma. RESIDENCE. Residencia: t a S * .i; s: z w — 4) «) « :c. — o SI be 5 «5 a s a a > ^ "3 o Bayamon: Seventh thousand 1 1 Sipthno miliar. 1 Total 1 1 u 1 1 Sai.to: Second thousand.. Third thousand Fourth thousand.. Fifth thousand Sixth thousand Seventh thousand. Total . Beatriz: Second thousand. Total. Rio abajo: Second thousand.. Third thousand Fourth thousand.. Fifth thousand Sixth thousand.... Seventh thousand. 4 4 8 1 2 1 4 4 6 3 1 14 1 5 5 6 17 10 8 8 1 27 1 1 1 24 2.5 18 H I 71 71 Total . 1 1 1 1 ; 1 1 1 1 4 3 2 3 12 6 1 ■0 7 1 11 3 1 1 17 4 7 8 8 2 1 30 1 1 1 2 ' 5 29 16 11 6 2 69 Sur: Second thousand.. Third thousand Fourth thousand . . Fifth thousand Sixth thousand Seventh thousand. Total. Ceiba: Third thousand. Fifth thousand.. Sixth thousand . Total. Monte li.ano: Fourth thousand. Fifth thousand 1 4 6 3 5 4 4 6 1 2 2 2 2 1 4 16 22 1 2 3 2 3 5 2 1 1 4 3 5 3 1 12 12 Total. 1 1 1 1 2 2 ANEMIA IN PORTO RICO. GrRADE Forma. e KESIDEXCE. 8 8 S s Jlfxiileiicia. S .c ii i i p-i S 1 s S S 1 Very 1 Muy 2 a; 11 5 o Rinc6n: Fourth thousand 1 1 Ciitii-iii iiiillfir. Fifth tliousand 1 1 Qiiiiito miliar. Sixth thousand 2 2 1 5 Sexto miliar. Total ' 3 3 1 7 7 Arenas: Fifth thousand 2 1 3 Total 2 1 3 3 MUXICIPALITY OF MOROVIS. Miinioijialidad de Morovis. Town of Mokovis: Pueblo de Morovis: First thousand . Total. BARRIO: Pkrcha: Fifth thousand. Total. MUNICIPALITY OF CAGUAS. ' Municipalidad de C'aguas. Town of Caguas. Pueblo de Vaguas. First thousand.. Third thousand. Fifth thousand.. Sixth thousand. Total. BARRIO: San Sai,vaI)Ok: Seventh thousaml... Total. 1 1 1 1 2 MUNICIPALITY OF NARANJITO. Municipalidad de Xaranjito. Town of Naranjito: Pueblo de Xaranjito: Second thousand Total. 1 1 1 1 1 1 4 ANEMIA IN PORTO RICO. xxxi Forma. RESIDENX'E. Residencia. Very light. Mny benigna. e s be g 5 01 II i i > ^ •c e 1 « I. 5 o BARRIOS: Cedko abajo: 1 1 Cuarto miliar. Total 1 1 1 Cedro arrib.\: Fourth thousand. Fifth thousand Sixth thousand. . . Total. 1 1 ■:> 2 1 4 1 5 i 3 4 1 , 8 8 MUNICIPALITY OF AGUAS BUENAS. Municipal idad de Aguas Buenas. BARRIOS: Juan Asexcio: Second thousand 1 1 2 Total 1 1 2 2 Bayamoxcito: Third thousand 1 1 1 2 1 Fifth thousand Total 2 1 3 3 SUMIDERO: Sixth thousand 1 1 Total 1 1 1 1 1 MUNICIPALITY OF SALINAS. Municipalidad de Salinas. Town of Salinas: Pueblo de Salinas: Fourth thousand .. 1 1 2 Total 1 1 2 2 BARRIOS: | Lapa: \ Second thousand Third thousand ' 1 1 2 1 1 1 Sixth thousand 1 Total : 2 2 1 2 7 Aguirre: Fifth thousand 1 Total 1 1 ANEMIA IN POKTO RICO. Forma. e KKSIDEXCE. livsitlfiicki. Very light. Muy benigna •a s Medium. Mediana. Intense. Intensa. Very intense. Muy intensa. Unclassified. No clasiftcad Total. Tlilril ihousanil. 'J rri-tr iiii/lo: i'licOlii lie Utiiado: Third thousand Javvya: Seventh thousand... Total. City ok San Jian: CHudfid de Nan Juan: Fourth thousand.. Total. MrNK'll'AIJTY OF COROZAL. Miitiicipaliiliiil dr Corozal. 1 1 3 3 4 4 4 MUNICIPALITY OF UTl'ADO. Municipal idad de Utuado. 1 1 1 1 2 2 2 MUNICIPALITY OP SAN JUAN. MunicipaUdud de Sun Juan. MUNICIPALITY OF ARECIBO. Municipalidad de Arecibo. MUNICIPALITY OF JUANA DIAZ. Municipalidad de Juana Diaz. Town ok.Ivana Diaz: I'uehli) dc Jiiaiia Diaz: l''lfth thousand.. Sixth tliousand . Total. BARRIO: Caonii.la akriba: Fourth thousand Fifth ihousanil. Total . Town ok Arecibo: I'ueblo de Arecibo: Fourth thousand 1 1 Total 1 1 1 1 1 2 1 1 I 1 1 3 3 1 1 1 1 1 1 2 ANEMIA IN PORTO RICO. RESIDENCE. Residencia. Town of FAjARDf): Pueblo de Fajardo: Fifth thousand. Total. Town of Ciai.es: Pueblo de Ciales: Fifth tliousand . Total. Forma. -w .*> 3 a^ 0) ^ a 5 c s MUNICIPALITY OF FAJARDO. Municipalidad de Fajardo. MUNICIPALITY OF CIALES. Municipalidad de Ciales. MUNICIPALITY OF SANTA ISABEL. Municipalidad de Santa Isabel. Town of Santa Isabel: Pueblo de Santa Isabel: Fifth thousand.. Sixth thousand. Seven thousand. Total. 1 1 1 1 1 1 1 1 2 4 1 1 2 1 1 2 6 6 * Each case received a serial number on admissiion to treatment, and the information contained in the total of 18,865 cases was recorded on clinical cards bearing these numbers. Some of the them were accidentally omitted, others duplicated, so that, at this Central Station the actual number of cards by thousands is as follows: * Cada caso recibib un nUmero serial al admitirse en tratamiento y la informacibn contenida en el total de 18,865 casos fue hecha en tarjetas clinicas correspond ientes d aquellos niimeros. Algunos de estos fueron accidentaimente omitidos, otros duplicados, de modo que, en esta Estacibn Central, el numero actual de tarjetas por niillares es el siguiente; From 1 to 1000 999 Z)e d 1001 •• 2000 998 2001 •• ;M00... 996 3001 •■ 4000 1007 4001 ■• 5000 1000 5001 ■• 6000 1015 6001 " 6136 137 Total 6152 ANEMIA IN PORTO RICO. TABLE 4. COLOR OF PATIENT COMPARED WITH THE CLINICAL TYPE OF UNCINARIASIS. CENTRAL STATION, AIHONITO. CUADRO 4. COLOR DEL PACIENTE COMPA- RADO CON LA FORMA CLlNI- CA DE LA UNCINARIASIS. estaciOn central, aibonito. CLINICAL TYPE. forma clfnica. Very light ^f||y hpitiffiiit Light livniijmi Medium Intense Intensa Very Intense May intensa Unclassified. ... yii rliixijlcddux 502 1.361 1,123 5-16 102 92 Total 3,726 171 712 654 235 20 54 1.846 277 2,350 188 1,965 28 809 6 128 12 158 580 6,152 SUBSTATION, BARRANQUITAS: Very light Muy beniffiia Light Benign ft Medium Mediana Intense Interna Very Intense Muy intensa Unclassified Ao clasi/icados Very light .Viiy benign a Light Benign (I Medium Mriliaud Intense Intrnsn Very intense. . yiiiy inleiisfi Total. 1 1 135 1 186 1,154 50 4 1.208 72 1 73 3 3 1 4 1,369 51 5 1,425 1,425 SUBSTATION, COMERIO: 122 478 Total. 459 260 70 1,389 10 65 157 25 17 274 132 549 619 : 87 I 1,676 ANEMIA IX PORTO RICO. CLINICAL TYPE. 00 o ? Forma cUnica. 2 e St?- s J si ^^ g^ zfe^ i 5 O H Very light Mtii) benigna Light Bcnif/na Medium Med i ana Intense Intcnsa Very intense. . Muy intensa Very liglit Muy benigna Light Ben if/na Medium Median a Intense Intensa Very intense. . Mini intensa Total. Total. Very light Muy benif/na Light Benif/na Medium Mcdiana Intense Intensa Very Intense Mny intensa Unclassified No clasificados Very light Muy benigna Light Benigna Medium Mediana Intense Intensa Very intense. . Muy intensa SUBSTATION, COAMO: 63 117 189 103 16-1 8 275 188 206 1 305 85 84 169 13 7 20 452 .578 18 1.048 1.048 SUBSTATION, BARKOS: 4 4 1.55 6 1 162 581 57 7 615 3W 28 412 31 1 32 1,155 91 9 1.255 SUBSTATION, GUAYAMA: 24 I 85 257 172 i 31 Total 577 SUBSTATION. SAN SEBASTIAN: Total. 47 3 50 127 12 2 141 223 9 6 238 191 8 2 201 32 1 33 620 33 10 663 1.255 4 3 31 40 7 132 70 5 332 24 5 201 o 1 37 8 13 148 21 746 746 663 ANEMIA IN PORTO RICO. TLINICAL TYPE. Forma cllnicn. a> ci 5 ° Ss ij ^^ :5 ** •se; t*?? SUBSTATION. MOCA: Very llRht Mini lirnignn l.lKlit /If nil/ nil Meilliitn Mid ill II fi Iiitt-nse Inlrnna Very Intense Mill/ inti-nun rnclasslfiert jVo rlnsijicfidox Total. SUBSTATION, UTUADO: Very light Miiy ben ill 11 a Light lirnigtifi Medlnni Mi'iliaiia Intense Inlrnsa Very intense .^fiifi inli'iixri Unclassltieil So elfisiflcudiiK Total. SUBSTATION. LARES: Very lifrhl .l/(/,i/ hi-nii/na l.lKlit..... lliii if/nri -Medium Mriliiinii Intense Jnlriisn Very Intense Mill/ inli'ii.sd Unclassified AV) clasificfidox 5 2 7 &1 o 66 1 4 9 9 Ti 4 9 86 86 180 44 2 226 531 112 7 653 533 131 12 676 149 17 1 167 17 1 18 73 73 1,413 305 22 73 1,813 Total I 3,887 3 3 78 78 2,553 9 2,562 1.171 5 1,176 82 82 100 100 3,887 14 100 4,001 ANEMIA IN PORTO RICO. TABLE 5. * COLOR OF PATIENT COMPARED WITH THE RELATIVES NUMBER OF UNCINARIA EGGS FOUND ON MICROSCOPIC EXAMINATION. CUADRO 5. * COLOR DEL PACIENTE COMPA- RADO CON EL NIJMERO RELATIVO DE HUEVOS DE UNCINARIxV ENCONTRADOS EN EL EXAMEN MICROSCOPIC©. (!KNTRAT^ STATION, AIBONITO. ESTAC'ION CENTRAL, AlBONITO. RELATIVE NUMBER. NUmero relativo. CO ^ SI o j; ^ o — s 5 o H 35 1.052 1.759 834 16 11 449 892 472 19 4 107 330 134 5 53 1.608 2.981 1.410 70 Muchisimos Many Mucho.i Alguiws Pocos Mxy Pocos Total 3.726 1.846 580 6,152 6.152 SUBSTATION. COMERIO: Great many.. Muchlsimos Many Muchos Moderate Algunos Few Pocos Very few Muy Pocos Total. 88 11 1 103 556 122 5 683 85 2() 2 113 628 111 5 744 32 1 33 1.389 274 13 1.676 1,676 SUBSTATION. COAMO: Great many.. Muchlsimos Many Muchos Moderate Algunos Few Pocos Very few -1/(/^ Pocos Total. 200 192 53 452 6 190 281 100 1 578 13 :-i 393 9 182 6 159 1 18 i,ai8 ANEMIA IN PORTO RICO. RELATIVE XIMHER. .Xiimero relalivo. «5 |i 2| 2 * 11 is "5 o H Great niauy.. ^fllrhixitllns Many Miirhos Moderate Algunog Few Pucos Very few -l/'i/i/ I'nrox Total. Great many. . Miich!.nns Many Mtiffios Moderate Algunog Few Pocos Very few Mii)i piicii.s Total. (ireat many. . ^furhf shuns Man y Mil rill IS Moderate Algunog Few Pocos Very few Mini Piiros Total. (ireat many Miteh'isiinos Many Miichos Moderate Algunog Few Pocog Very few Muy Pocog Unclassified Ao Clagificadog Sl'HST.XTION, BARROS 7 7 lUi 6 1 126 8!iO 73 7 970 137 12 1 150 2 2 1.15.5 91 9 1.2.55 SUBSTATIOX, GUAYAMA: 85 13 1 99 390 101 17 511 86 27 2 115 10 4 1 15 6 6 577 148 21 746 SUHSTATIO.N. \N .'SEBASTIAN I 87 I 13 194 69 18 620 ! 33 SUBSTATION. UTUADO: 9 467 163 699 7 107 1 253 2 214 71 18 10 663 Total ! 1,413 9 80 8 555 31 8 202 172 6 877 22 97 73 73 305 22 73 1,813 1,818 ANEMIA IN PORTO RICO. RELATIVE NUMBER. yCtmero relativo. Great many Muchisimos Many Miichos Moderate Algunos Few Pocos Very few Mtiy Pocos Unclassified Xo Clasificaclos Total. S oi A "^ «; o JS ■S 8 ?2 Ce. » s=; o O H SUBSTATION, LARES: 12 1,294 2,296 7 7 266 19 3,887 14, 100 12 1,301 2,303 266 19 100 4,001 * The substations at Barranquitas and Moca, not being provided with microscopes, are not included in this table. * Las sub-estaciones de Barranqii Has y Moca no fueron provislas de microscopio y no estan incluidas en este cuadro. xl ANEMIA IN PORTO RICO. TABLE 6. AGE PATIENT COMPARED WITH THE CLINICAL TYPE OF UNCINARIASIS. C K N T K A L Station, A i b o n i t o . CUADRO 6. EDAD DEL PACIENTE COMPA- RADA CON LA FORMA CLlNI- CA DE LA UNCINARIASIS. EsTACioN Central, Aibonito. »5 ^^ > > > > > ?;^ S ,^ 'x; In "w ■« ^. s 3 S S 3 3 !:; o CLINICAL TYPE. ^ '^ a a a C ^ % s Forma cllnica. ovs 0>8 « 2 o *^ •:: 0) .J B ^ c; ^ b^ o^ < < C-l Very light 16 122 198 273 105 18 8 9 742 Miiy benigna. LlRht 45 382 5;i5 882 377 80 37 12 2.350 Benigna. Medium 17 212 369 806 427 86 43 5 1,965 Mcdiana. Intense 4 35 159 353 196 40 13 9 809 Intensa. Very intense 1 10 75 30 5 g 1 128 Muy intensa. Unclassified 4 19 99 65 32 9 6 1 158 •Vo clasificada. Total 86 771 1,293 2,454 1,167 238 113 30 6,152 6,152 Very light Muy benigna. Light Benigna. Medium Mediana. Intense Intensa. Very Intensa Mill/ inlrnsa. Unclassified No clasificada . Total Very light May benigna. Light Benigna. Medium Mediana. Intense Intensa. Very intense... Muy intensa. SUBSTATION, BARRANQUITAS. 1 1 8 27 36 40 21 2 2 136 3 137 2&1 481 244 29 20 1,208 1 6 13 24 25 4 73 2 1 3 3 1 4 12 170 314 550 292 35 99 1,425 1,425 SUBSTATION, COMERlO: Total. . ■ 8 23 37 41 20 3 132 17 65 122 178 137 23 7 549 i ^^ 74 169 260 90 8 3 619 7 30 80 95 55 15 7 289 ji 8 16 34 21 6 2 87 47 200 424 608 323 55 19 1,676 i,m ANEMIA IN PORTO RICO. xli «0 £'S Ol 0) a) (U «■ =5 > > > > t» 11 CLINICAL TYPE. "a o "3 'o § a Forma cllnica. 03 5* 5 ^§ Oi d =0 ^? ■o a -e " r. o-e S'S 2"8 3^ 2"s V. s 5 ^Q lO o lO g o o Q be 5 o H ' Very light 3fuy henigna. Light Benigna. Medium MediaJia. Intense Intensa. Very intense.. Muy intensa. Total. Very light Muy benigna. Light Benigna. Medium Mediana. Intense Intensa. Very intense. . Muy intensa. Total. Very light 3fuy benigna. Light Benigna. Medium Mediana. Intense Intensa. Very intense Muy intensa. Unclassified Ko clasificada. Total. Very light Muy benigna. Light Benigna. Medium Mediana. Intense Intensa. Very intense. . Muy intensa. SUBSTATION, COAMO: 1 43 57 50 30 7 1 189 I 35 80 91 55 11 3 275 2 34 109 188 88 19 5 395 8 36 67 46 9 3 169 \ 3 8 8 1 20 ! a 123 282 354 227 47 12 1.048 SUBSTATION, BARROS: 3 1 4 3 20 35 66 29 8 1 162 21 78 159 217 123 27 20 645 18 38 63 163 93 22 15 412 4 11 4 8 4 1 32 42 140 268 453 254 61 37 1,255 1,255 SUBSTATION, GUAYAMA: I 2 4 12 9 3 1 31 2 9 35 53 25 5 3 132 1 23 78 131 77 13 9 332 1 17 39 92 40 2 10 201 • 5 6 12 10 4 37 2 1 3 6 1 13 6 57 165 306 162 27 23 746 SUBSTATION, SAN SEBASTIAN: Total. 181 230 2 1 1 50 21 7 1 141 48 13 4 238 44 10 2 201 11 5 33 126 36 8 663 ANEMIA IN I'ORTO RICO. ( 1-lNirAI, TYl'E. Formn citnica. B-c ' 2"c 0) S Very light Mill/ belli;/ no. I.i«lit Itcniiina. Medium Media iKi. Intense Ill ten sa. Very intense Miiy iiitensa. Unclassified .Xo cldsijieados. Total. \'ery ligtit Mil)/ Oeni(/iici. Light Benign a. Medium Mediami. Intense fiitensfi. Very intense Mill/ inteiisa. Unclassified .Yo clasi/icados. Total. Very light Mni/ benigna. Light lienignn. Medium MediiiiKi. Intense Iiilensfi. Very intense Miiy intense!. Unclassified Xo clasi/icados. Total. SUBSTATION, MOCA: 1 2 5 5 1 5 7 7 2 66 1 4 9 9 33 ! SUBSTATION, UTUADO: 86 86 3 16 51 95 53 ^ 1 226 1 57 135 288 149 17 6 653 1 37 118 304 177 28 11 676 8 39 67 45 7 1 167 2 2 8 3 1 18 ' 73 78 7 120 345 762 427 59 20 73 1.813 1.818 SUBSTATION. LARES: 2 1 3 13 24 34 7 78 22 202 540 1.141 549 83 25 2,562 1 12 74 173 517 314 70 16 1,176 2 5 14 25 20 5 11 82 100 100 36 294 751 1.719 890 158 53 100 4.001 ANEMIA IN PORTO RICO. TABLE 7. * AGE OF PATIENT COMPARED WITH THE RELATIVE NUMBER OF UNCINARIA EGGS FOUND ON MICROSCOPIC EXAMINATION. CUADRO 7. * EDAD DEL PACIENTE COMPA- RADA CON EL NtJMERO RELATIVO DE HUEVOS DE UNCINARIA ENCONTRADOS EN EL EXAM EN MICROSCOPICO. CENTRAL STATION, AIBONITO. ESTACION CENTRAL, AIBONITO. 00 w IS (0 > SI > a) > > i^ ^ - 2 S 2 V. ^ RELATIVE >■ ..^ — — — — — ■■:; o i NUMBER. ir: ^ a P - a c 5. 01 t ?:uniero relative. X! ;; _; ■2 2 ~ "2^ •^ ~v M ■> 2^ p »^ S'c o-«f o »^ S ~ a s 03 ^ >s .-. o £ 2 o > ^ o ^ be 5; O Very few 12 16 23 13 3 3 70 Muy pocos Few 37 250 279 5&1 235 47 20 8 1,440 Pucos 39 375 651 1.175 561 112 54 14 2.981 Algunos Many 10 132 337 670 345 71 36 7 1.608 Muchos Great many 2 10 22 13 5 1 53 Muchisimos Total 86 771 1,293 2,454 1,167 238 113 30 6.152 6,152 Very few Muy pocos Few Pocos Moderate Aid linos Many Muchos Great many. Muchisimos Total SUBSTATION, COMERIO: Very few 6 15 15 10 1 8 92 23 68 9 7 171 6 212 28 10 Muy pocos Few 290 Pocos Moderate 30 Alfjunos Many 249 Muchos Great many Muchisimos 29 Total 47 200 424 608 2 33 138 29 9 744 26 9 4 113 127 13 4 683 80 4 2 103 323 55 19 1,676 1.676 SUBSTATION, COAMO: 30 61 2 66 144 1 27 73 « 4 3 123 282 1 1 41 1 24 3 159 140 99 23 8 482 ino 99 20 4 393 3 J> 1 13 a54 ! 227 47 12 1,048 1,048 xliv ANEMIA IN PORTO RICO. o > 6 > 6 > 6 > > |l g « s s 2 a «i o 2 RELATIVE >».s -■ CJ a o NUMBER. a a n a a •8 S ; Xumero reUitivo. 2« 2« §3 o ^^ lO o IX g g o Q > t» > •si S 2 "m *a? *u5 'm •^ RELATIVE NUMBER. n "O ^'"S S a q "3 a 3 a 1) Numero relativo. ^ 2 o * ^ 2 5 "^ o-e S-e Ovs S"® to -c 01 a t (J) e "3 ^q lO o lO o g Sq SI 5: o Very few Muy pocos Few Pocos Moderate Algunus Many Muchos (ireat many MuchisimuH Unclassified No clasificados Total . 6 26 41 25 181 531 11 83 169 1 4 36 294 751 SUBSTATION, LARES: 8 101 1,056 550 4 1,719 4 1 19 87 8 8 266 389 70 48 2,303 408 79 1 1,301 2 1 12 100 100 890 158 53 100 4,001 4,001 *The substations at Barranquitas and Moca, not being provided witli microscopes, are not in- cluded in this table. *Las sub-estaciones de Barranquitas y Moca no fueron provistas de microscopio y no estan incluidas en este cuadro. xlvi ANKMIA IN PORTO RICO. TABLE 8. CUADRO 8. RESULTS COMPARED WITH THE CLINICAL TYPE OF UNCINARIASIS. CENTRAL STATION, AIBONITO. RESULTADO COMPARADO CON LA FORMA CLlNICA DE LA UNCINARIASIS. ESTACI6N CENTRAL, AIBONITO. CLINICAL TYPE. Forma cttnica. Very light Muy benignu Light Benign a Medium Mediana Intense Intensa Very intense Muy intensa Unclassified. ... No clasificados Total. Very light Muy benigna Light Benigna Medium Mediana Intense Tntensa Very intense Muy intensa Unclassified No clasificados Total. Very light Muy benigna Light Benignu Medium Mediana Intense Intensa Very intense.. Muy intensa 340 1,048 784 325 54 68 402 1,301 1,181 480 65 90 2,619 SUBSTATION, BARRANQUITAS 3,519 347 1,076 SUBSTATION, COMERIO: Total. 55 77 49 500 44 575 83 205 10 77 241 1,434 1 35 101 >76 931 1 28 44 1 3 4 742 2,350 1,965 809 128 158 6,152 1 136 1.208 73 3 4 6,152 2 I 1,425 J 1,425 132 549 619 289 87 1,676 1,676 ANEMIA IN PORTO RICO, xlvii £ ° CLINICAL TYPE. 05 ^ .— Formn cltnica. 'b"2 e2 3 erf g ■a "s. ■3 H Very light Muy benigna Light Benigna Medium Mediana Intense Intensa Very intense. . Muy intensa Very light Muy benigna Light Benigna Medium Mediana Intense Intensa Very intense. . Muy intensa Total. Total. Very light , Muy benigna Light Benigna Medium Mediana Intense Intensa Very intense Muy intensa Unclassified No clasificados Total. Very light Muy benigna Light Benigna Medium Mediana Intense Intensa Very intense.. Muy intensa SUBSTATION, COAMO: .37 152 189 52 223 275 59 336 395 23 ^ 146 169 4 1 14 2 20 1 175 i 871 2 1,048 1,048 SUBSTATION, BARROS: SUBSTATION, GUAYAMA: SUBSTATION, SAN SEBASTIAN: 4 4 82 80 162 392 253 645 238 172 2 412 14 15 3 32 730 520 5 1,255 6 25 31 5 127 132 10 320 2 332 2 198 1 201 35 2 37 5 8 13 28 713 5 746 746 13 37 50 19 122 141 25 212 1 238 18 182 1 201 4 29 33 79 582 2 663 663 xlviii ANEMIA IN PORTO RICO. CLINICAL TYPE. Forma clUiica. Very light Mity beniynit Light lieniyna Medium Mediana Intense IiUensa Very Intense... May intensa Unclassified Xo clasijicadd Very light Muy ben igiia Light Benigna Medium Mediana Intense Intensa Very intense... Muy intensa Unclassified A^o clasi/icada Very light Miiy benigna Light Benigna Medium Mediana Intense Intensa Very intense... Muy intensa Unclassified No clasi/icada Total. Total. SUBSTATION, MOCA: SUBSTATION, UTUADO: 61 128 134 27 ■I SUBSTATION, LARES: 5^ 165 525 Wl 140 14 1,385 7 7 66 66 4 4 5 2 2 9 5 79 2 86 226 653 1 676 167 18 73 1 1,813 86 1,813 Total. 1 2 3 31 47 78 1,023 1,534 6 2,662 W7 811 18 1,176 17 55 10 82 100 1,419 2,449 33 4,001 ANEMIA IN PORTO RICO. xlix TABLE 9. RESULTS COMPARED WITH TO- TAL NUMBER DOSES OP ANTHELMINTIC. CENTRAL STATION, AIBONITO. CUADRO 9. RESULTADO COMPARADO CON EL NUMERO TOTAL DE DOSIS DE ANTIHELMlNTICO. ESTACION CENTRAL, AIBONITO. DOSES OF ANTHELMINTIC. Ddsis de antihelmintico. U K One Two Three Four Five Six Seven Eight Nine Ten Eleven Twelve Thirteen Fourteen Fifteen Sixteen Seventeen Eighteen Nineteen Twenty Twenty one Twenty two Twenty three Twenty five No dose administered No recibieron antihelmintico. 46 187 312 357 362 300 268 200 153 104 95 73 60 33 34 16 6 6 4 1 669 393 446 291 288 154 159 98 93 53 57 26 36 17 14 11 11 5 Total 2,619 3,519 SUBSTATION, BARRANQUITAS: 693 717 586 759 619 650 454 427 298 247 157 152 99 96 50 48 27 17 11 6 2 1 3 1 2 6,152 ; 6,125 One 1 3 7 29 59 93 80 50 20 \ 40 174 129 127 126 145 83 83 58 63 33 11 2 2 1 1 40 175 129 131 134 174 142 176 Two Three Four Five Six Seven. . Eight Nine . 138 Ten 113 Eleven 53 Twelve 15 3 2 Thirteen Fourteen Total 347 1,076 2 1,425 1,425 AN KM! A IN POKTO RICO. nOSES OF ANTHELMINTIC. /) 303 182 90 272 142 30 2 174 74 13 87 45 14 59 21 21 10 •1 14 2 1 3 1 1 1 1 730 520 5 1,2.55 ANEMIA IN PORTO RICO. DOSES OF ANTHELMINTIC. Dosis de antihelminiico. B^ « '«> a >5 SUBSTATION, GUAYAMA. One Two Three Four Five Six Seven Eight Nine Ten Eleven Twelve.... Thirteen . . Fifteen Seventeen. Total. SUBSTATION. SAN SEBASTIAN. One Two Three Four Five Six Seven Eight.... Nine Ten Thirteen Total. SUBSTATION, MOCA. One Two Three Four Five Unclassified Xq clasificados. Total. SUBSTATION. UTUADO. One... Two... Three. Four. . Five.., Six . . . Seven , Eight. Nine. . 1 1 224 3 228 ! 3 140 2 145 5 105 110 5 101 106 3 38 41 30 32 2 9 ^1 1 2 25 27 8 »! 2 18 20j 3 5 ! 8 8 j 1 1 2 1 1 2 2 28 713 5 746 ! 141 1 1 135 1 10 113 11 78 16 44 11 36 11 18 11 7 6 7 2 2 79 1 .582 2 142 I 137 123 89 I 60 I 47 i 29 18 13 4 1 663 1 663 31 31 21 1 22 2 12 1 15 2 10 12 1 3 4 5 ' 2 77 2 2 86 1 9 10 47 303 1 351 118 125 . 243 73 294 .367 46 95 141 50 327 377 14 85 99 4 94 98 1 27 28 lii ANEMIA IN PORTO RICO. DOSES OF ANTHELMINTIC. D6sis de onlihrlmUitieo. 00 O c 5 a s OS S a* § s 5 a: 5 5 22 3 1 73 22 3 1 73 Xo clasijicudas. Total 354 1,385 1 73 1.813 1,813 SUBSTATION, LARES. 8 86 410 488 Five 290 Six . . . 88 36 Eight 8 Nine 1 Ten 9 Eleven 9 Unclassified No clasificadas. Total 1,419 562 12 582 677 13 776 569 5 981 346 3 837 165 455 73 9 161 35 71 16 24 4 5 1 3 1 3 100 100 2.449 33 100 4,001 4,001 ANEMIA IN PORTO RICO. liii TABLE 10. NUMBER OF PATIENTS CLAS- SIFIED ACCORDING TO USUAL LOCALITIES WERE MAZAMORRA IS CON- TRACTED. CUADRO 10. NUMERO DE PACIENTES AGRU- PADOS DE ACUERDO CON EL SITIO MAS FRECUENTE EN QUE CONTRAJERON LA MAZAMORRA. Coffee plantations Cafetales, Coffee plantations and sur roundings of home Cafetalcs y cercanlas cle la vivienOn. Surroundings of home only,. Cercanlas de la vivienda so lamente. Open country Pastos, Roads and paths , Caminos y veredas. Rivers, streams and pools of water, Hios, qucbradas y tanques de agua. Town streets Calles de la poblacion, Stables and corrals, Eslablos y corrales. Tobacco plantations Siembras de tabaco, Banana patches Platanales, Sweet potato patches, Batatales, Sugar plantations, Canaverales, Surroundings of public schools, Cercanlas de escuelas pd- blicas. Unclassified, No clasiftcados, Persons with eggs of uncina- ria in their stools, who de- nied having suffered from mazamorra Personas que con huevos de uncinaria en sus evacua clones, negaron haber pa decido de mazamorra. 3,876 215 515 652 25 12 19 127 146 826 37 Total 6,152 1,425 1.676 1,048 1,255 2 a 3 O CO O 747 33 649 609 200 90 25 31 957 158 49 s a 324 213 91 m S 746 2 -a 530 1,224 663 294 120 2,567 13 1,111 1,813 liv ANEMIA IN PORTO RICO. TABLE 11. COMPLICATIONS AND INTERCURRENT DISEASES. Centkal Station, Aiiionito. CUADRO 11. COMPLICACIONES Y ENFERMEDADES INTERCURRENTES. Estacion Central, Aibonito. Tropical Diseases: Enfermedades tropicales: Filariasis 7 Elephantiasis 2 Chronic ulcer of the leg 31 Ijiccra crdnica de las piernats Dysentery 22 Bilharziosis recti 5 Malaria 29 L'liknown 1 Clinically diagnosed. Diagnosticada clinicamente. Loosely termed, "anemic ulcer", "tropical ulcer", etc. Often due to severe secondary in- fection following mazamorra. Impropiamente llamada "illcera cmemica,'' 'Wtlcera tropical,''' etc., es debida frecuentemente d infecciones secundarias consecutivas d ''la via- zamorra'". Confirmed as amebic dysentery by micro- scopic examination in several cases. The type was usually chronic and the clinical picture was the same. All were probably due to ameba coli. Con/fnnada como disenterta amebica par exd- men uiicroficopico en algunos ca.so.s. La forma fu6, gei).eralmente, crdnica y el tipo clinico el viismo. Todax fueron, probablemente, debidas d ameba coli. Diagnosed by microscopic examination. Diagnosticada por e.rdmen )nicrosc6pico. Included here because tropical forms pre- dominated. Almost always diagnosed by microscopic examination. Incluida aqui porqiie predominaron lasfor- mas tropicales. Las mds de las veces fue hecho el diagn6stico por el exdmen microscdpico. This disease, to which reference was made in the last report of this Commission, is termed "La Hermosura" ("The Beauty") by the coun- try folk and is characterized by anasarca, fever and tendency to fatal termination. There may be no albumin in the urine and even no anemia. It is regarded by some as a form of acute uncinariasis. Esta enfermedad d la que se hizo referenda en el anterior informe de esta Comisidn es lla- mada "La Hermosura^' por los campesinos, y se caracteriza por anasarca, fiebre y lendencia d ANEMIA IN PORTO RICO. Iv an t&rmino fatal. No es segura la presencia de albUmina en la orina y puede observarse en in- dividuos no anemicos. Es considerada por algu- nos como una forma de uncinariasis aguda. Affections Which May Be In Some Manner Related To Uncinariasis: Afecciones que pueden de algun modo relacionarse con la unci7iariasis: Icterus 4 Stomatitis 2 Cataract 11 One of these cases was a boy of only twelve years of age. The cataract Avas complete and not congenital. •Uno de estos casosfue un muchacho de doce anos de edad. La catarata era completa y no congenita. Night blindness 2 Probably many more existed but the question Ccguera nocturna Avas put to but few patients. We have noticed that it is not an unfrequent condition. Probablemcnte es tnwcho mayor el nfimero pe- ro la preguntafue hecha d pocos pacientes. No- sotros sabemos que no deja de ser frecuente. Nystagmus 4 Retinal hemorrhage. . . 1 Partial amaurosis 7 Pathological condition not known. Condicion patologica desconocida. Vicarious menstruation 1 Menstruacion suple- mentaria. Gangrene of legs 1 Due to failing oircvilation and extreme edema. Gangrena de las pier- Debida dfalta dc circulacidn y d gran edema, nas. General Infectious Diseases: Enfermedades infecciosas generales: Pulmonary tuberculo- sis 32 Not a very freciuent disease in the country. A large proportion came from the town. No es muy frcquente en el campo. Un consi- derable nCimern -viene de las poblacioncs. Tuberculosis of the la- rynx 2 Tuberculosis de la la- ring e. Tuberculosis of hip joint 1 Tuberculosis de- la articulaciCn de la cadera. Scrofula 1 Lupus 2 Cervical adenitis, tu- bercular 3 IvJ AN KMT A IN PORTO RICO. Tuberculosis, elbow joint 1 Idem 1 7 3 49 6.50 5.431 3a5 414 i:iO 15 864 3.201 1 ..569 106 36 8 8 1,727 •».24;i 242 3 1 1 247 4.241 675 5 680 4.93;^ 469 32 18 11 12 ,542 5,655 788 273 67 29 80 5 1.242 5.676 :i87 19 406 5.807 325 128 1 U 17 12 497 6.080 312 9 12 j 333 5.944 626 9 19 : 654 3.475 801 379 279 66 38 1,566 3.605 978 2.58 26 .56 65 4 1,387 5,808 96 9 7 3 j 115 4,647 .386 51 89 U 2 .. .542 5,537 ! 693 108 182 37 68 22 60 1.195 3.783 63 10 73 3.1<)0 .503 235 92 113 43 5 ; 995 3.:i56 2.372 307 28 17 2,724 3,206 2.007 201 15 2 8 1 2,234 5.5.33 708 233 5 946 4, '.131 339 2 8 2 1 3.52 5,826 94 .58 U 1.52 5.626 662 62 2 •- 726 5,60it 178 372 100 185 185 12 1.032 5.K0'.i 97 9 2 18 4 15 159 4.197 1.587 141 22 18 10 1.778 5,802 432 495 233 76 70 10 1.316 5.237 725 166 76 12 117 12 1.108 5,8»8 115 19.128 103 17 .. 2:35 Total 1 I 4.207 1.470 743 .599 215 55 60 26,477 I'erreiUage expelled: 72..34r 15,8 f'romrtlio rrpiilxado: 5.55+ 2.80+ 2.26+ .81+ .20+ .22 -r Coniparison between effect of thymol and beta-uaphthol, percentages expelled at each dose: ('oiiiptiidriiiii , ntrr fl efecto del timol y naftol beta: promedio expiilsado por cada dosis: •"hyniol; 76.85^ 1.5,.54+ .5.16+ 1..51 f .73- '/"; ini>l : I'.eta-iiaphthol: 72.24^ Xii/tril-ljetii: Moth drn>r.s: 71.51 ..4 itd>n.s dni;/iix: .12+ .04- 15.88- .5.55- 2.80- 2.26- .81+ .20^ 15.71- 5.35- 2.15 r 1,49-r .46- .12- .006- .22 + .113- Jl UNIVERSITY OF CALIFORNIA LIBRARY Los Angeles This book is DUE on the last date stamped below. :§ 2 5 1967 ;r £B 2 R£(m Form L9-25m-9,'55 (B4283s4)444 =e^ R<-. J W2. 190-5 __y 3 1158 00551