PUBLIC RECORD OFFICE
Reference :-
C.O.885
ALLY WITHOUT PERMISSION OF THE BE REPRODUCED PHOTOGRAPHIC- COPYRIGHT PHOTOGRAPH—NOT TO
19 PUBLIC RECORD OFFICE, LONDON
182.
control the disease appear to have been pursued in a manner more or less spasmodic and desultory, lacking continuity of system and sustained application, and they do not seem to have yielded very fertile results.
In my Annual Report, 1907-8, recently submitted, attention was directed to the probably fallacious statistics available on this subject, which although indicating a pronounced decline in the general prevalence of the disease within the last two years are at variance with the expressed opinions of medical officers of districts where it is known to exist and who comment freely upon its marked increase and the wide dispersion of it taking place in the absence of restrictive action. At the outset, therefore, I am faced with want of accurate knowledge of the actual prevalence and distribution of the disease here; the results of enquiry and my own observations, however, confirm my opinion and that of others that it is undoubtedly prevalent here in no small degree.
I think it would be futile to resume the application of previous methods now more or less in abeyance, without at the same time endeavouring to arouse amongst medical officers, estates proprietors, employers of labour, and others directly or indirectly affected by the incidence of the disease, a renewed general and practical interest in its control and suppression, and to me it appears that this aim might best be achieved by cancelling or withdrawing all former circular letters, instruc- tions, recommendations, forms of returns, &c., and starting afresh with a clean slate, as it were, and a revised scheme of operations, which should include in its details some of the methods already approved and found effectual here, as well as additional features that have commended themselves to other workers in the same field else- where and are adaptable to local circumstances.
Full particulars of the proposed scheme are not yet matured, but the outlines upon which I suggest it should be developed are directed towards :--
1. The prevention of soil contamination with infected human excreta.
2. The provision by estates authorities of microscopes and simple apparatus
for diagnostic purposes at estates hospitals.
3. The education of the labouring population to an elementary knowledge of
the nature of the disease and the rationale of the methods adopted to suppress it.
4. The treatment of individual cases.
5. The treatment of disease en masse.
6. The preparation of accurate statistical returns showing the prevalence,
distribution, &c., of the disease.
In reply to the despatch from the Secretary of State, No. 354, dated the 20th November, 1907, which was referred to me on the 12th December last, I beg to submit the following particulars answering enquiries under the several para- graphs of it.
Paragraph 5. I forward statistical tables which are the best I can procure, but for reasons stated above I believe the figures to be unreliable; most of the medical officers report an increased prevalence of the disease both in its cutaneous and intestinal manifestations during the rainy seasons. Medical officers report that the disease does not exist in Tobago, nor in Toco, where East Indian immigrants are altogether absent or very sparsely distributed amongst the native population.
(a) I am not able to ascertain that any sanitary measures for dealing with the disease are at present systematically or seriously in force in the Colony; on one estate I believe the use of tar is continued with some success.
(b) Medical Officers unanimously report the absence of any latrine accommoda- tion at labourers' barracks on estates in their districts: estates hospitals are all provided with privy accommodation, where the pail system is usually installed but badly operated in many instances. There are no public conveniences in villages and centres of population except at Court Houses and such-like places of public resort; privy accommodation amongst dwellings of the peasantry is either very primitive (a dilapidated wooden hut with or without a shallow subjacent pit) or entirely absent indeed it may be accepted that only at better-class houses is there to be found anything approaching suitable sanitary convenience.
The Wardens are the Sanitary Authorities and the Sanitary Inspectors of their respective districts, and are in some instances provided with Assistant Sanitary Inspectors; their supervision appears to be exercised perfunctorily or not at all, other duties seemingly absorbing all their time to the exclusion of the work that in their views can be most easily and indefinitely postponed. As opportunity
183
occurs I am endeavouring to replace Wardens' Assistant Sanitary Inspectors by men possessing some special training and experience, to improve their status and to ensure that their whole time is available for sanitary duties.
(c) The usual methods of treatment are in vogue here and are employed almost exclusively at estates and district hospitals; I do not think any general efforts have been made to treat patients at their homes or in dispensary practice, cases mostly coming under observation in aggravated conditions of the disease with prominent symptoms and complications. Thymol-eucalyptus oil with chloroform, and male fern are the drugs chiefly resorted to here; I think the former is not always exhibited in the dosage most approved by experienced observers, and beta naphthol, which is strongly recommended in preference to thymol certain cases, does not appear to have been tried here. Medical officers here generally lay stress on the value of subsequent dietetic and ferruginous tonic treatment, contrary to the experience and practice in Porto Rico, where the after use of iron especially is regarded as un. necessary if not harmful, rapid recovery in most cases being noted to follow the extrusion of the parasites after thymol or other specific treatment in sufficient dosage. Observers in Porto Rico record the great difficulty of eradicating the disease in old, and still more so in very early, infections; it appears that ova very often disappear from the fæces after mild treatment, to appear again in the course of two or three weeks quite apart from any subsequent re-infection; therefore the practice seems sound to continue thymol, even in the absence of ova, so long as a low hæmaglobin index or a continuance of symptoms is noted; in these cases iron and dietetic treatment without rethymolising would obviously be ineffectual. Suggestions obtained from medical officers in reply to circular letter I addressed to them as to what local measures might be taken :-
1st. For the treatment of ankylostomiasis in plantations. These include :-
Treatment in hospital of every recognised case, routine examina- tion of the stools of all admissions to hospital, careful disinfection of alvine evacuations, routine treatment with thymol of all anæmie cases, send convalescents to seaside, local application of tar to feet and legs.
2nd. For the treatment of ankylostomiasis en masse.
Free medical attendance.
Establish dispensaries and at least one special hospital in each district.
3rd. General and special sanitary measures, improved water supply, distri- bution of leaflets describing the nature and cause of the disease, use of incinerators for disposal of fæcal matter, compulsory provision of latrines in villages under careful supervision, treatment of all immi- grants on the voyage here from India, contaminated lands to be ploughed and freely limed, &c.
I am not to be understood as recommending or agreeing with all of the above suggestions. For the eradication of ankylostomiasis in Trinidad the key of the whole situation lies in the prevention of soil contamination by infected human excreta. Universal application of treatment to cure a labouring population already, I believe, only sparsely infected, or even the immigrant section of it, is impracticable were it even necessary. A continual stream of immigrants pours annually into the Colony, of whom reliable observers declare about 75 per cent. to be infected before departure from India; the disinfection of these by treatment at the Calcutta depôt prior to embarkation and on board during the voyage here is held to be inexpedient by the Surgeons-Superintendent and medical officers, and consequently the popula tion here is exposed to annual diffused re-infection from this source.
All prophy- laxis is doomed to failure that omits to take into primary account the continuously increasing propagation of the disease by the habits of the class it most largely affects, and unfortunately the radical measures that alone and of themselves can command success are inimical to the customs of the East Indian and are subversive of the time-honoured, though filthy, habits of the general labouring population. But well- directed and persistent efforts, tactfully applied and aided where need be by com- pulsory measures, should ultimately produce a substantial improvement in the general conditions and a gradual reduction of the numbers of infected individuals with corresponding decrease of soil contamination.
As regards indentured immigrants, I see no reason why the compulsory use of latrines at their barracks and in the fields, as well as in the depôt, ships, and estates
183
PUBLIC RECORD OFFICE
Reference :-
C.O.885
19 PUBLIC RECORD OFFICE, LONDON
ALLY WITHOUT PERMISSION OF THE BE REPRODUCED PHOTOGRAPHIC-
COPYRIGHT PHOTOGRAPH—NOT TO
urs I am endeavouring to replace Wardens' Assistant Sanitary Inspectors by men sessing some special training and experience, to improve their status and to ure that their whole time is available for sanitary duties.
(c) The usual methods of treatment are in vogue here and are employed almost lusively at estates and district hospitals; I do not think any general efforts have n made to treat patients at their homes or in dispensary practice, cases mostly aing under observation in aggravated conditions of the disease with prominent aptoms and complications. Thymol-cucalyptus oil with chloroform, and male n are the drugs chiefly resorted to here; I think the former is not always exhibited the dosage most approved by experienced observers, and beta naphthol, which is ongly recommended in preference to thymol in certain cases, does not appear to re been tried here. Medical officers here generally lay stress on the value of sequent dietetic and ferruginous tonic treatment, contrary to the experience and ctice in Porto Rico, where the after use of iron especially is regarded as un- essary if not harmful, rapid recovery in most cases being noted to follow the rusion of the parasites after thymol or other specific treatment in sufficient lage. Observers in Porto Rico record the great difficulty of eradicating the ease in old, and still more so in very early, infections; it appears that ova very en disappear from the fæces after mild treatment, to appear again in the course two or three weeks quite apart from any subsequent re-infection; therefore the actice seems sound to continue thymol, even in the absence of ova, so long as a hæmaglobin index or a continuance of symptoms is noted; in these cases iron 1 dietetic treatment without rethymolising would obviously be ineffectual. ggestions obtained from medical officers in reply to circular letter I addressed them as to what local measures might be taken :—,
1st. For the treatment of ankylostomiasis in plantations. These include:-
Treatment in hospital of every recognised case, routine examina.
tion of the stools of all admissions to hospital, careful disinfection of alvine evacuations, routine treatment with thymol of all anæmic cases, send convalescents to seaside, local application of tar to feet and legs. 2nd. For the treatment of ankylostomiasis en masse.
Free medical attendance.
district.
Establish dispensaries and at least one special hospital in each
3rd. General and special sanitary measures, improved water supply, distri- bution of leaflets describing the nature and cause of the disease, use of incinerators for disposal of fæcal matter, compulsory provision of latrines in villages under careful supervision, treatment of all immi- grants on the voyage here from India, contaminated lands to be ploughed and freely limed, &c.
I am not to be understood as recommending or agreeing with all of the above ggestions. For the eradication of ankylostomiasis in Trinidad the key of the iole situation lies in the prevention of soil contamination by infected human creta. Universal application of treatment to cure a labouring population already, elieve, only sparsely infected, or even the immigrant section of it, is impracticable re it even necessary. A continual stream of immigrants pours annually into the lony, of whom reliable observers declare about 75 per cent, to be infected before parture from India; the disinfection of these by treatment at the Calcutta depôt ior to embarkation and on board during the voyage here is held to be inexpedient the Surgeons-Superintendent and medical officers, and consequently the popula in here is exposed to annual diffused re-infection from this source. All prophy- ria is doomed to failure that omits to take into primary account the continuously creasing propagation of the disease by the habits of the class it most largely affects, d unfortunately the radical measures that alone and of themselves can command ocess are inimical to the customs of the East Indian and are subversive of the ne-honoured, though filthy, habits of the general labouring population. But well- rected and persistent efforts, tactfully applied and aided where need be by com- dsory measures, should ultimately produce a substantial improvement in the general aditions and a gradual reduction of the numbers of infected individuals with rresponding decrease of soil contamination.
As regards indentured immigrants, I see no reason why the compulsory use of trines at their barracks and in the fields, as well as in the depôt, ships, and estates