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To my mind it is not a difficult matter to rid a district of anchylostomiasis, but it is the influx of outsiders-and here the annual allotment of immigrants from Tudia comes in—coupled with the general insanitary conditions especially prevalent in villages and those free estates, which tends to keep up a constant source of infection.
Gewral measures in villages.– Public latrines and washhouses, a proper water supply, and a sanitary inspector, rather than an overseer to collect rates, are much needed in villages.
The earth system in villages, as obtains in removal of excreta from Public Hospital, New Amsterdam, might also with advantage be adopted in some villages, The ordinary statutory or, more correctly, the broad irrigation plan modified. measures suffice to carry out sanitary work in my opinion, but, as special sanitary measures, might be mentioned a steam destructor in Georgetown and perhaps other Government institutions. Septic tanks might also be mentioned.
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may he let out when required; in some places water could be run in when required from the estate" supply system. Along the sides of the trench a fence bush be grown so as to protect it from view.
:
I think this trench system is applicable to most estates and some of the villages, but in the scattered villages I do not know of any system to suggest. With them latrines would be kept like they keep their closets, in a most insanitary condition.
Yours, &c.,
C. P. KENNARD.
The Honourable
The Surgeon General.
(Circular. No. 14.)
j
PUBLIC RECORD OFFICE
Reference :-
minimimi C.O.885
19 PUBLIC RECORD OFFICE, LONDON
ALLY WITHOUT PERMISSION OF THE BE REPRODUCED PHOTOGRAPHIC- COPYRIGHT PHOTOGRAPH—NOT TO
28 January, 1908.
II.
W. J. VON WINCKLER.
Government Medical Officer.
SIR.
REPORT by Dr. C. P. KENNARD re the Treatment of Anchylostomiasis on : and the General and Special Sanitary (1) Plantations; (2) "En masse Measures.
SIR,
Inve the honour to inform you in answer to Part 2 of your circular. 2143/07. dated 21st January, 1908, re anchylostomiasis:--
1. For the treatment of anchylostomiasis on plantations.—I think it specially important that the new coolies should be all treated at first if they show any signs of anæmia at the inspection; after should be examined for ova and treated again if found, or if they are in hospital for anything; with regard to the rest of the estate people to treat any who from any symptoms show ova.
2. For the treatment of auchylostomiasis “ en masse."--I do not think this is possible: in the first place it could not be effectually carried out, even supposing the whole population was treated, all the worms would not be cleared out; secondly, I do not think the majority of the population require it; and, thirdly, unless latrines were supplied beforehand it would spread about the ova in a more con- centrated manner.
3. General or special sanitary measures.—I do not think that anchylostomiasis can be ever stamped out completely, because no matter how good the latrine accom- nodation. people, especially children, will defecate anywhere when they wish to; and it has not been definitely proved that the anchylostome is not hetero- genetic. Giles and Sandwith hold that it is (Allbut's System of Medicine, 1907. Volume 11, Part 2). Its occurrence in pygmies, the bucks of this Colony, and general wide distribution favour this.
There is no doubt, however, that it can be minimised by precautionary methods, which means a latrine system.
The difficulty of latrines is, that they must be ample for the population, and must be situated near the houses or they will not be used.
I do not believe in dry latrines, as with them typhoid fever and other lowel complaints may be carried by means of flies which are very prevalent on this coast To avoid this I consider that it is essential that the stools should be passed
at times into water.
On the river, latrines can be easily placed over the river; on the coast estates. there is a great difficulty where to put them. There is generally on each estate a waste ground which the people use for defecation. I would suggest that a long and fairly deep trench be dug across this, the earth from it thrown up on the edges so as to raise the sides; across this at frequenf intervals, slightly separated, double posts or spars be placed, a screen, one or more, be placed across the trench and sides from side to side to divide the women's part from the men, the end of the trench coming close to the side line so that water may be taken in or that the water
Surgeon-General's Office, Georgetown. 2 February, 1588.
Anchylostomiasis.
THE presence of anamia amongst the population of the Colony is a fact brought prominently under notice in the different reports on medical subjects which reach me day by day.
No doubt, in many instances, the anæmia so noted is dependent upon incipient phthisis or chronic Bright's disease. But eliminating these causes and others com- nion to all countries, malarious or non-malarious, there remain cases of apparently idiopathic anæmia, frequently described as tropical anæmia.
For some time it has been suspected that in this country, as in some other parts of the tropics, the so-called tropical anaemia was often due to, or associated with, the presence in the intestines of the parasite known as the unchylostomum duodenale. With a view to determining the question a search for the helminth was lately instituted at the Public Hospital, Georgetown. Dr. Ozzard, who undertook the enquiry, has already proved that the suspicion was well-founded, and that the anchylostomum is to be met with in a large proportion of cases passing through the hospital. He has prepared specimens of the parasite for microscopic examination, and these can be seen at the hospital by anyone taking an interest in the matter. They present the character described and figured by Dr. Cobbold, in the article "Sclerostoma," in Quain's Dictionary of Medicine, an article which contains a con- cise and clear account of the helminth and the disease supposed to ensue from its presence. It has been thought advisable to address this letter to you to ascertain whether your attention has previously been drawn to the existence in the Colony of the anchylostomum, and if so to ask that you will kindly communicate the results of your observations.
As far as I am aware no information of the kind has yet been made public. It ✨ is evident that the fact of the occurrence of the parasite has more than a purely scientific interest. It is one which is of practical importance in the treatment of disease: as, supposing such a cause he operative, anemia at times may be more effectually remedied by a course of anthelminties than by the administration, with- out these, of iron and restoratives.
To all Government Medical Officers.
(Circular. No. 240/11,883.)
I have, &c..
ROBERT GRIEVE,
Surgeon General.
SIR,
Surgeon-General's Office, Georgetown, 14 December, 1901. THE existence of anchylostomiasis in this Colony was first brought_promi- nently to the notice of Government medical officers by the late Surgeon-General (Dr. Grieve) in a circular letter, No. 14, dated the 2nd February, 1888.
2. Since then it has been proved that the disease exists in every part of the Colony, and is extending to an alarming extent.
3. The mortality returns directly attributable to this disease are small, but it is open to grave doubt whether some deaths at present attributed to other diseases
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