PUBLIC RECORD OFFICE
Reference :-
C.O. 885
24 PUBLIC RECORD OFFICE, LONDON
ALLY WITHOUT PERMISSION OF THE BE REPRODUCED PHOTOGRAPHIC- COPYRIGHT PHOTOGRAPH-NOT TO |
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fasting, etc. On the following morning they went from house to house, giving the thymol and keeping the patients under observation. At 11 a.m. they gave to each patient the last saline purge, and saw that it acted thoroughly before they allowed the patient to eat or to leave his premises.
One week later the patients received their second treatment, given in the same way, and to each successive week until cured. The nurse and his assistant are expected to secure specimens for re-examination from patients who have had two treatments, at least six days after the last treatment, and to bring them into the office weekly thereafter until they are found cured. This phase of the work must be watched carefully to prevent confusion.
Should the "daily" method of treatment be used some changes in the above- mentioned force would be necessary.
The Medical Officer, ohief clerk, assistant clerk, and microscopist would remain the same, but there would be a pioneer to each 3,500 inhabitants, and a distributor of thymol to each 200 infected cases. These distributors may be had at an average salary of $8.00 to $10.00 per month.
8. Financial Procedure.
1. Following the visit of Mr. Wickliffe Rose, Director-General of the Inter- national Health Commission, to British Guiana, in the autumn of 1913, on which occasion offers of assistance in the eradication of ankylostomiasis were made to that Colony, a budget was prepared by the Surgeon-General providing for eradi- cation work in a definite territory-Peter's Hall District-during one year. This budget was submitted to the International Health Commission, and adopted. Following their approval of the budget, that portion of the funds to be furnished by them was paid through the Receiver-General into the Government Treasury in quarterly instalments, and disbursed through the same channels and under the same restrictions as control Government expenditures.
2. It was understood that these funds were to be made available by submitting to the Surgeon-General of the Colony a written and itemized requisition, signed by the Supervising Medical Officer of the eradication campaign and the Govern- ment Medical Officer of the district where operations were in progress. These requisitions were countersigned by the Surgeon-General and forwarded to the Treasury, where payment was made at the end of each month. The same procedure applied to all invoices and itemized bills.
3. It was agreed that all vouchers should be made out in triplicate, so that a copy might be supplied to the Receiver-General, the Treasury Department, and the International Health Commission.
4. A copy of the budget under which he was operating was supplied to the Supervising Medical Officer, and it was agreed that, at all times, expenditures must be kept within the amounts allotted to each head or item of the budget.
5. A separate account was kept for each budget in operation, both by the Surgeon-General's office and by the chief clerk of the force.
6. At the month's end a statement of expenditure under each budget was prepared by the chief clerk and compared with the accounts being kept in the Surgeon-General's office.
7. A quarterly report of expenditures in each area was prepared in the Surgeon-General's office and sent to the International Health Commission, together with the usual quarterly report of work done.
8. It was agreed that a report of the auditing of the funds furnished by the International Health Commission should be sent them from the Auditing Department of the Government semi-annually.
9. Duration of Campaign.
With the "intensive" method of treatment fifty per cent. of the cases treated in Meadow Bank village, British Guiana, were cured in two weeks, that is, they were examined, found to be infected, and given the first treatment at once; a week later they were given the second treatment; and six days later they were re-examined and found cured, Thirty-five per cent. were cured with three treatments, which required three weeks; and fifteen per cent. required from four to six treatments, consuming a maximum time of six weeks. In actual experience all infected cases in a given territory can not be put on treatment simultaneously. With the force provided for in the preceding pages, making due allowance for contingencies, the campaign in a given territory should be completed in four months from its inaugura- tion whenever the "intensive" method of treatment is used. The campaign in
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Meadow Bank village was completed in two months, from which fact it may be seen that the above estimate allows for twice the time required in actual experience. With the "daily" method four months are required for the treatment of the individual case. Recent reports from British Guiana indicate that fifty per cent. are cured in three months, but we can not yet be certain how long it may take to cure the remaining fifty per cent. Present information indicates strongly that the campaign in area B, Peter's Hall Distriot, where the " daily" method of treatment is being used with 1,800 cases, will be completed on 31st December, 1914, or eight months from its inauguration. It is probably safe to estimate that, under average conditions, with the use of the "daily" method of treatment, a campaign in a given territory will require from eight to twelve months.
10. Sanitary Measures for Prevention.
The International Health Commission undertook in Peter's Hall District, British Guiana, to locate and cure, as far as was possible, every person affected with ankylostomiasis, and to educate the people, with literature and illustrated lectures, in modern sanitation and preventive measures. In this work they were to have the support and co-operation of the Government, which would undertake to inaugurate such sanitary changes and improvements in the district as would reduce the dangers of re-infection to a minimum.
As the whole question of the prevention of the spread of ankylostomiasis is simply a question of preventing the ova-impregnated fæces from being deposited on the surface of the ground, where, in the presence of moisture and oxygen, the eggs will hatch into the infective embryos, our attention was naturally centred on the privies or latrines in use in this district. There were three types in use. Many of the homes in the village were found unprovided with latrines of any sort, but the cane patches and the "bush" were used instead as places of concealment. Others had latrines which were for concealment only, as all night-soil fell upon the surface of the ground, to be scattered about by fowls, beating rain, etc.
On the sugar estates the latrinest in common use by the indentured labour are built of sheet-iron, except the floors and frames, and located over the "drainage trenches." All dejecta fall into the trenches, and as long as the water therein stands at its normal height these latrines largely prevent ankylostomiasis infection. It often occurs, however, that the water level recedes, exposing areas of mud- bottom contaminated with viable ankylostome eggs, and other pathogenic organisms too numerous to mention; and when children and others wade into and across these infected spots, they cannot well avoid contracting a case of ankylostome ground itch."
*
The third type of latrine was the so-called "pit-privy," in common use in the United States, and by far the most effective of the three.
These privies are constructed as follows: A pit of proper dimensions, and three
to four feet deep, is dug. Over this pit are placed the seat and light superstruc- ture, so that all night-soil falls directly into the pit. The earth is banked up around the lower edges of the latrine walls to keep out water. The seat should have a cover which will only stay up when occupied.
When the pit becomes filled with night-soil to within a foot or so of the top, another pit is dug near by, and the seat and superstructure are moved over it, the old pit being filled up with earth.
This latrine is inexpensive, it does not require cleaning, can easily be made fly- proof, and prevents the spread of disease-breeding filth. With its construction and general use the spread of ankylostomiasis will be checked, typhoid will become rare, and bowel-disorders will become less frequent.
The improvement in sanitary condition by the Government force has kept pace with the progress of the curative measures of our campaign in British Guiana.
Latrines of either the trench or pit type have been put in by the people at practically every home in area B, and steps are being taken to secure like results in the other areas.
The existence of compulsory laws has made it possible to secure very prompt. action in the district on sanitary matters.
*These homes are indicated on our sanitary report sheet as F types.
These are designated as E type in our sanitary sheets.
This type of latrine is classified as D type on our weekly report sheet.