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Is HONOUR,
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Dr. CLAVIER to ADMINISTRATOR.
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ANKYLOSTOMIASIS in a greater or lesser degree is distributed all over the Second Medical District. I have not noticed that it is more prevalent in any special quarter. About an equal number of suspected cases have been sent by me to the Victoria Hospital from Anse-la-Raye, Soufrière, and Choiseul. Many refuse to go to hospital, which is the only place where they can be properly treated. It may be interesting to note that I had a case last week at Anse-la-Raye of a boy who com- plained of fever.' lle presented a fairly typical appearance of ankylostomiasis, he had "a temperature "and a pretty extensive dermatitis on one foot. He refused to go to hospital.
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At the dispensary, patients suspected and asked to bring, on the morrow, some of their fæces in a match box for microscopical examination almost invariably over- look doing so.
I am fairly well convinced that a very large percentage of the inhabitants of the island, if an examination were made, would show infection, but to arrive at anything like an accurate conclusion about localities of infection, I agree with Dr. King that. the Victoria Hospital books will give the most reliable information.
12 December, 1907.
HIS HONOUR,
Dr. LESTRADE to ADMINISTRATOR.
D. J. P. CLAVIER.
ANKYLOSTOMIASIS is prevalent in most of the districts of the island; but especi- ally so in those subjects who live on damp clayey soil, and whose houses are not floored with planks, but are earth-floored. Drinking of pond water is also a fruitful cause of it. The localities in my district where it is most prevalent are Augier, a mountain plateau east of Black Bay Estate. La Grace and Borico, also mountain plateaus east of Retraite Estate.
Mal d'estomac " was the ancient name for this disease before its parasitic nature was ascertained about 25 years ago. (Worker on St. Gothard's tunnel and in Egypt.) Wherever you find this disease, yaws is also prevalent. It is common in infants and adults, and particularly in the former, and they are known and called carth-eaters. I have met several cases coming from Cayenne among the gold- seekers. The parasites themselves are more widely spread among the population than might be suspected by the casual observer; but the disease as such only affects the susceptible, and those whose power of resistance is below par. The toxin gene- rated by them at such times poison the blood, and produce all the traces of symptoms observed in this disease.
16 December, 1907.
HIS HONOUR,
Dr. HUGHES to ADMINISTRATOR.
J. A. L.
Is the Fourth District Ankylostomiasis is most prevalent in the Mabouya Valley, and especially sugar estates in this valley.
A large percentage of cases treated are returned Cayenne labourers.
21 December, 1907.
19828
No. 71.
WINDWARD ISLANDS: GRENADA.
THE GOVERNOR to THE SECRETARY OF STATE.
A. F. H.
139
November, 1907, relative to the question of ankylostomiasis, to enclose copies of the replies of medical officers of Grenada dealing with the subject.
2. The delay in replying has been due to the reference which I have been obliged to make to British Guiana, where your Lordship says that the measures taken have "met with a gratifying degree of success.”
3. It would appear that in that Colony the action taken is that of a voluntary carrying out by the planters of recommendations by the Surgeon-General, as (to quote the Government Secretary of British Guiana) “employers recognise the advan- tages of having their labourers employed in the field instead of becoming chronic invalids and spending their time in hospital."
As far as I am aware, Guiana employs indentured labour with a barrack system. The employer has to keep and give medical attendance to his people, and the doctrine that it is better to incur the small outlay necessary for preventive measures than to have sick labourers on his hands is too obvious to need much inculcation, while the fact that the labourers on the estates are actually and personally subject to the direct control of that estate and subject to penalties for breach of such control gives to the employer and to the Government almost unlimited power. No legis- lation, therefore, would appear to have been necessary.
4. In Grenada all is different. There is no indentured labour, no barrack system, no continuity of labour, and no responsibility in respect to labour. One or two of the very largest estates have a few people housed near their works, but in a minor degree, not worth consideration.
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5. A man or woman comes or goes-works when times are busy and idles when times are slack. Of course to a certain extent planters employ and encourage those of the better class of labourer who come and settle in their immediate neigh- bourhood, and such may be said to get fairly continuous employment from year to year. But the people move at the merest whim, pull down the few rickety boards which constitute their houses and cart them along a road to some other place where they may have acquired what they call a "house spot." In fine, employers have no responsibility in respect to their people, nor people in respect to their employers. Employers have absolutely no control over the dwelling places of the people nor any nfeans of enforcing any serious sanitary control.
6. Of course, it is competent to order every employer to put up latrines on his estate, but the labourers may live miles from that estate. It is easy to give orders that, on that estate, no labourer may foul the ground but must use latrines; but in small industries such as prevail here such an order would be ineffective. Planters could not put latrines here and there over their estates, and, if forced to do so, their headmen would not enforce usage and the people would laugh at it. Planta- tions consist of extremely steep hills and valleys so that the labourers are scattered hither and thither on the hill sides.
6. Punishment is possible, but one cannot punish a whole population, and, as your Lordship knows, regulations and punishments against which there is a dead wall opposition on the part of an entire people cannot be enforced even at the point of the bayonet and certainly not by a few extremely weak and ineffective policemen.
7. Mr. Cork, in his despatch to me of the 7th of April. 1905, No. 37.† speaks of making employers responsible for the cost of hospital treatment. Mr. Cork has, I fancy, in his mind the four big sugar usines in St. Lucia, where such a procedure might be possible, but even in St. Lucia that would not touch the bulk of the population.
8. Besides which it must not be lost sight of that the enforcement of such a rule, the moment it was known that it was to apply to ankylostomiasis, would assuredly cause every employer to forthwith dismiss from his employment any labourer as to whom there was the least chance of his incurring liability, and would at once, as I believe, throw a very large number of men and women out of employment, whom the Government would have to tend and feed, and for which there are no funds available.
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9. The Medical Board of St. Lucia, in sub-section 2 of their report, say: the treatment of ankylostomiasis en masse. This is a very difficult question, and we are of opinion that it would be quite impossible to carry it out here." In this the Medical Board of St. Lucia practically throw up the sponge as far as they are concerned, contenting themselves with a few obvious platitudes.
(Received June 1, 1908.)
[Answered by No. 73.]
(No. 77.)
MY LORD,
Grenada. 12 May, 1908.
I HAVE the honour, in reply to Lord Elgin's despatch.. No. 120, of the 26th of
No. 10 in Miscellaneous No. 201.
196
Enck sure in No. 70,