PUBLIC RECORD OFFICE
Reference :-
C.O. 885
22 PUBLIC RECORD OFFICE, LONDON
ALLY WITHOUT PERMISSION OF THE BE REPRODUCED PHOTOGRAPHIC- COPYRIGHT PHOTOGRAPH-NOT TO|
24
against it are recorded; though its mode of transference has been known for thirty years, and it is probably easily reducible in towns. It is probably much more prevalent than is shown by the Returns.
Malaria is summarised in the Abstracts I. and II. The final percentages are calculated from the totalled actuals and not from the sum of percentages; and Colonies which show no figures on a particular point are omitted from the per- centages regarding that point-as remarked in the footnotes at the bottom of the columns.
The total population of the twenty-one Colonies and Protectorates was twenty- two millions, averaging a million each; but the detailed figures are given only for about ten millions of these. The average density of population was returned at 28 per square mile; the average birth-rate at 2:85 per cent., and the average death- rate at 2:37 per cent.-a little less.
The number of admissions into hospitals for malaria alone numbered 31,311, or no less than 16'6 per cent. of the total admissions for all diseases.
Similarly, the attendances at hospital and dispensaries for malaria alone amounted to more than half a million, or 222 per cent. of the total attendances.
It should be remembered that these large figures apply only to a total popu- lation of about ten millions, with comparatively few hospitals; and that they give the rates principally for natives-who are supposed to be comparatively immune against malaria.“
It should also be remembered that only a small proportion of the total cases of malaria ever attend the hospitals and dispensaries at all-especially cases among children.
The figures should be fairly accurate because the diagnosis is made by medical men or qualified assistants.
►
It is impossible to compute the malaria death-rate among the general popula- tion, but this is generally held to lie somewhere near 0'5 per cent of the total cases. The seasonal death-rates given by Meldrum's law in Abstract I. cannot be relied upon for one year alone, and especially for Colonies where the rainfall is fairly evenly distributed.
There is practically no endemic malaria in the Bahamas, St. Kitts-Nevis, Mont- serrat, Barbados, Seychelles, and Fiji-all small islands or groups of small islands. In the remaining Colonies it causes from about 8 per cent. to about 50 per cent. of the total sickness, and probably largely aggravates other diseases.
The cost of the disease, either to the Governments or to the public of the Colonies, cannot be ascertained from the Returns, but, owing to frequent deaths. invalidings, loss of labour, and medical treatment, must be very large. In the small island of Mauritius alone, it was estimated by the Medical Officer of the Immi- gration Department to be over Rs. 800,000 a year.
The preventive measures adopted are summarised in Abstract II. The total expenditure of the Colonies (excepting Gambia Protectorate) is put at £10,530,338, of which £775,144, or 74 per cent. was for medical and sanitary matters, including (I suppose) the salaries of the medical officers and their assistants, the upkeep of the hospitals, and the cost of sanitary work (generally exclusive of municipalities). The expenditure on sanitary work alone was put at £81,896, or only 13 per cent. of the total expenditure and 10.5 per cent. of the total medical and sanitary expenditure. This appears to be small; but many of the Returns have probably not discriminated properly regarding this column, while others are probably not accurate.
There were 719 government medical officers employed during the year, exclusive of 367 pricate practitioners. The total pay of the former is returned as amounting to £229,837, or 28 per cent. of the total medical and sanitary expenditure, and 2·8 times the sum reported as being allotted for sanitary work alone. It is to be inferred titat the remainder of the total medical and sanitary budget, namely, £463,411. was spent on the hospitals and dispensaries, medical offices and stores, &c. At all events it would appear that the money spent upon prevention bore only a small proportion to that spent upon cure.
The total revenues of the towns in twelve of the Colonies is given as being £820.647, of which 149.467, or 182 per cent. were allotted for medical and sanitary work. This is naturally a higher percentage than the similar rate for rural areas, and probably includes most of the cost of town-conservancy and street drainage, and, occasionally, of town improvements such as clearing marshy and overgrown lots.
Coming. now to the special efforts against the mosquito-borne diseases, we find that a total of £16,262 was spent on major works," which would include large
25
drainage and other reclamation works, “training
"
of streams, &c.—not including, I presume, such work done in towns. The expenditure under this heading amounts only to 0 16 per cent., or about 1/646th part of the total expenditure of the Colonies, and to 21 per cent. of the total medical and sanitary expenditure.
Minor works are those done by ordinary sanitary labourers against mosquito- breeding, such as keeping the ground clear of stagnant water, cleaning up yards, and so on. For effective work of this kind sufficient men must always be employed to keep the areas in their charge clear all the year round. According to the Returns, however, only 311 men altogether seem to have been specially employed for this purpose in the 21 Colonies. This is about 15 men for each Colony on the average: and only one man for every 71,000 of the total population. There were 23 times as many Government Medical Officers, and 3-5 times as many medical men in the Colonies. Doubtless, however, much similar work was done in towns by the ordinary sanitary labourers or by gangs of prisoners.
So far as I can extricate the figures from the Returns, only about 3,832 pounds of quinine were distributed in all the Colonies during the year. We gather from our researches in Liverpool that one pound of quinine can scarcely suffice for the com- plete treatment of more than ten cases; so that the 3,832 pounds actually given out would be little more than sufficient for the 31,311 cases actually admitted into the hospitals, and would not nearly suffice for the 547,040 cases attending the dispen- saries--not to mention the millions of persons who were probably attacked with malaria during the year in the Colonies under consideration.
7. Remarks. My own conclusions, based on the study of all the documents referred to above, are as follows:-
(1) The Returns for 1910 evince much greater interest in the subject than was shown in most of the previous communications, and also record more active efforts against mosquito-borne diseases.
(2) Good Returns have been sent by most of the larger Colonies.
(3) Few of the Returns however give as complete information on the subject
as was possible.
(4) Several of them are perfunctory or unintelligent.
(5) Sometimes the writers do not appear to be well acquainted with sanitary science. For example, Question 17 (i) of the Return asks whether any steps were taken "regarding the housing of the poor." Every sanitarian knows that this means technically the subject of legislation, and the enforcement of legislation, regarding the building of sanitary dwellings for the poor almost the first principle of public health administration. Yet the writers of several of the Returns seemed to think that the question referred to the existence of houses!
poor
(6) The delay in the submission of some of the Returns, and the internal evidence of others, suggests that the heads of the Medical and Sanitary Department of some of the Colonies are not provided with a proper office (which is quite essential for such work); or else that they do not have at hand the elementary information asked for in the Return; or that they have not troubled to keep in touch with the work.
(7) It is doubtful whether the expenditure on sanitation is sufficiently large
as compared with that on medicine.
(8) The expenditure on the prevention of the mosquito-borne diseases com- pared with the total medical and sanitary expenditure appears to be much below the ratio which the frequency and importance of these diseases would seem to demand.
(9) The number of sanitary labourers employed on such work is obviously quite inadequate-a point often insisted upon (e.g., by the West African Sanitary Advisory Committee). It would probably be good economy to employ several hundreds of such labourers for every medical or sanitary officer appointed.
(10) Further organisation appears to be required.
8. Suggestions.-The following proposals may be offered for consideration:—
(1) That the Schools of Tropical Medicine be invited to institute special yearly three-months courses of instruction on tropical sanitation (by itself), and that the Universities concerned be asked similarly to give corresponding diplomas of tropical sanitation (by itself).
can say