PUBLIC RECORD OFFICE
16 Tz Ti
Reference :-
C.O. 885
ALLY WITHOUT PERMISSION OF THE BE REPRODUCED PHOTOGRAPHIC- COPYRIGHT PHOTOGRAPH—NOT TO
24 PUBLIC RECORD OFFICE, LONDON
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difficult to understand how lessons can be taught or learned when from two to five or six classes may be conducted at one time.
In one
The teachers were courteous and enthusiastic hygienists, and, of course, the children were interested in the new doctor and in the subject of his talk. or two instances a certain prudery was evident in the manner of teaching the crudities of hygiene, which reflected unsatisfactorily on the intelligent appreciation of the subject by the children.
The health of the children was, on the whole, good; the average attendance, which is about 50 per cent, of those enrolled, was well maintained during my casual visits; no epidemic cause of absence was in evidence, though "dysentery" and "fever" were complained of in more than one district; a certain amount of anæmia was found, especially amongst the infants and in certain defined localities.
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The food of the children seems to be little varied, “blugga "* and tea three times a day being commonly admitted; and variety amongst the mass of the children seemed to go no further than the addition of plaintain bread, and "hurelle other imported salt fish, to the same "blugga." The anæmia found cannot all be attributed to ankylostomiasis where such unvaried diet is the fare of the children. Undoubtedly, also, poor feeding will lay children open to the more ready chance of infection.
One or two The water supply of the schools in general is unsatisfactory. schools have water laid on, and at a few there is a tap on tlie road near by; but in most schools water has to be carried a considerable distance, and a scanty supply necessarily results.
The latrine service of the schools is on the whole not satisfactory; there has been an attempt to enforce generally the bucket and dry earth system, with very feeble result; in some instances deposit still is made on the exposed ground; in one locality the schools have no system whatever, and the children have to go to the sea or bush; at two schools there is a satisfactory pit closet.
The accommodation as a rule is inadequate, supervision is frequently remiss, and there is every likelihood that children spare the provision made and use the neighbouring plantations in many cases.
Conditions suggestive of malaria in school surroundings are rare and in the daytime should not affect children at school. In one school stegomyia mosquitoes were flying about the schoolroom in a district where fever was complained of. The teacher was unaware of the disease importance of this mosquito, and showed eagerness to get definite hygiene instruction.
The condition of the domestic animals in and around the homes of the people deserves careful observation to avoid possible transference of parasitic diseases. Here, as elsewhere in the tropics, broods of chickens die off frequently from different diseases, while pigs, dogs, mules, and horses display often an amount of bone and skin that suggests disease rather than mere starvation.
While there are allied worms parasitic on the lower animals, as the dog and the pig, the actual worms causing ankylostomiasis in man are at present supposed to be specifically limited to man; but for many reasons the health conditions of the domestic animals are of importance.
In the first statement of this report the general good health of the community was asserted, as also the fact that one third of the deaths yearly are due to intestinal diseases. That this has important bearings on the prevalence of intestinal parasitism there can be no doubt, and it were idle to discuss here whether the "dysenteries" and "diarrhoeas due to other causes lay individuals open to ankylostoma infection, or whether ankylostoma infection sets up and intensifies these diseases. The important point to bear in mind is that all these diseases are preventable, that they react on one another, and that the causes of all must be clearly ascertained and enunciated in order effectually to apply preventive
measures.
That one third of the total death rate of a community should be due to one group of diseases is serious enough, and when it is added that these diseases are preventable the matter is more serious.
That epidemics of dysentery and diarrhea originate in the tropics almost alone from water infection I unhesitatingly assert, and it is perfectly probable it may be proved here that water infection by skin or by mouth is a source of ankylos- toma infection also.
95
In reference to the customs of the people, some of which tend to insanitary conditions, I can find no prejudices likely to prevent change of habit. Tradition, imitation, convenience, and cost are the factors to be overcome.
The small East Indian population offers no complications.
In a country where dwelling houses may be erected without any provision being made for sanitary arrangements; where the houses of the well-to-do have been, and often still are, without any, or with only the most crude, sanitary arrange. ments; where opportunity of imitating better things has not been given to the people; the sanitary state of the homes and surroundings of the peasants need not be wondered at.
I must say I have found, especially amongst the mothers, a whole-hearted, desire for improved conditions and a declared intention of adopting suggested methods.
The people, in fact, are willing to be educated.
III.-Plan of Campaign.
For permanent result-for the eradication of hookworm from this island--it is obvious that the attack on conditions must be a determined conjoint systematic campaign of treatment and prevention-and of prevention again.
I especially emphasize prevention.
No law-made compulsory treatment of ankylostomiasis can expel the disease; isolation of all infected and treatment until the last hookworm has been poisoned is impossible. But it is possible so to limit the pollution of soil and water that infection or re-infection becomes practically impossible.
Expulsion of hookworm from Grenada, therefore, is within the bounds of practical sanitation.
The people are anxious to be treated; and are willing to be educated. Cure depends on the former, prevention on the latter.
In rough the scheme of campaign is :-
To treat appropriately and with appropriate drugs every person in the island requiring treatment; and by a system of inspection and education to bring it about that at the home of everyone treated a closet satisfactory to the treating authority is erected.
It may be necessary, in face of opposition, to produce fresh or amended legisla. tion; but I believe it will be advantageous to delay consideration of the legislative aspect of the matter, being satisfied that legislation meanwhile is ample to support the educative and suasive efforts of the Commission.
The actual scheme of operations which appears to me to be most thorough, economical of time, equably distributed, and capable of being overtaken, I attempt to lay out in form as concise and scheduled as possible.
1. The Medical Officer in charge is responsible for the whole work of him- self and staff; will initiate the field work at each separate location; will retain the bulk of the field work as his own active work; will examine patients; will deliver lectures and conduct demonstrations at the loca- tions as well as at headquarters and elsewhere for teachers and other bodies as arranged; will visit as convenient the homes of the people and add the weight of his suasion in matters of sanitary improvement; will report to the Governor as directed and as urgency demands.
2. The Assistant Medical Officer will have charge, in the absence of the Medical Officer in charge, at headquarters and at the locations, and will conduct operations; in the main his duties will be at headquarters while the Medical Officer in charge conducts the field work; he will conduct examinations and supervise the conduct of all examinations of the microscopists; shall daily report the results of each day's examination of samples; shall be responsible for recording results. shall attend to and treat patients at the office; shall demonstrate and lecture as arranged: shall carry out laboratory investigations into the means of spread and of prevention of spread of ankylostomiasis and other investigations into sanitary conditions as directed by the Medical Officer in charge, with the approval of the Governor, and shall report thereon; shall carry out any work consistent with the terms of his appointment as may be directed by the Medical Officer in charge with the approval of the Governor,
"Blugga
is a small banana-plantain.