CO885-24

PUBLIC RECORD OFFICE

Reference :--

CHC.O. 885

24 PUBLIC RECORD OFFICE, LONDON

ALLY WITHOUT PERMISSION OF THE BE REPRODUCED PHOTOGRAPHIC- COPYRIGHT PHOTOGRAPH-NOT TO

37348

(No. 261.) SIR,

No. 5.

BRITISH GUIANA.

THE GOVERNOR to THE SECRETARY OF STATE.

(Received 14th August, 1915.)

[Answered by No. 20.]

Government House, Georgetown, Demerara, 20th July, 1915. In continuation of my despatch No. 479, of the 21st November last,* I have the honour to transmit, under separate cover, twenty copies of a preliminary reportt on the amelioration and control of ankylostomiasis in the Peter's Hall District of British Guiana, by the Supervising Medical Officer, Dr. F. E. Field, with a covering letter by the Honourable K. S. Wise, Surgeon-General.

2. Printed copies of this report have been supplied to the International Health Commission.

Enclosure in No. 5.

I have, &c.,

WALTER EGERTON.

Surgeon-General's Office, Georgetown, Demerara,

SIR,

26th April, 1915. I HAVE the honour to forward the preliminary report on the amelioration and control of ankylostomiasis in the Peter's Hall District of British Guiana, by the Supervising Medical Officer, Dr. F. E. Field.

2. The report is a full one, and gives in excellent detail an exact account of the work performed. It lacks certain detailed statistical tables which will be forwarded

later.

3. This work began on 12th March. 1914, on which date Dr. Howard, the special representative of the International Health Commission, arrived in British Guiana. Dr. Howard remained in charge until July, at which time Dr. Field was specially seconded from the Colonial service to supervise the work. In each case the Supervising Medical Officer has had the advantage of the advice and special experience of Dr. Ferguson, the Government Medical Officer of the Peter's Hall District.

4. The object attempted was the systematic examination of all persons in the villages of the Peter's Hall District and the expulsion of all hookworms from those infected. The result has been a great reduction in the number of persons infected, a great reduction in the intensity of the individual infection, and a marked ameliora- tion of symptoms due to hookworm infection.

5. During the progress of the campaign special attention has been directed to the accuracy of the records, since some estimate was required of the effect of the Commission's operations, and no effort was spared to make it as complete and full as possible under the circumstances.

6. To diagnose the presence or absence of hookworm infection is largely a matter of microscopical technique, and paragraphs 10-18 of this report show the care devoted thereto. On the accuracy of these microscopical examinations rests the accuracy of the estimate of the campaign's value.

7. It must be realized that the earlier microscopical examinations had not the same thoroughness as those of a later period, and it should not be forgotten that the initial census error was probably from 18-29 per cent. of those examined. At the latter end of the campaign the error was reduced to about 3 per cent.

8. This campaign was carried out in a village population of 10,380 persons, with a known infection of 5,590 persons and a probable infection of 7,119; it has brought 5,160 persons under treatment by thymol; it has rendered 4,109 apparently free from infection but really only 3,986 (owing to microscopic error). The result is that probably 3,261 (31 per cent. of the 10,380) were at the beginning free from infection, while 7,255 (70 per cent. of the 10,380) were free at the end of the cam- paign. (Vide paragraph 21 of the report).

* 48945; not printed.

↑ Not reprinted.

Difficulties other than microscopical ones are illustrated in the various tables. especially that of paragraph 21. The inhabitants of these villages come and go at will; thus 105 per cent. (1,091) were not traced or departed after the census, some seeking work, or planting short crops temporarily elsewhere, others drifting in and out of the large city near by. Some persons evaded treatment, others flatly refused and repulsed all offers, a certain number abandoned treatment after begun, others again drifted away during the period of treatment. In this way 5-4 per cent. (582) were lost. Some few were too weakly and diseased to bear the treatment.

4-6 per cent. (484) had to be abandoned when it became necessary to close the campaign on 31st March, 1915.

10. While it will be possible in future work to reduce the microscopical error, difficulties such as the above will always influence adversely the possible results, though the various factors will vary with the position of the villages, with the season of the year, and so forth.

11. The campaign began on 12th March, 1914, and closed on 31st March, 1915. This is an unduly long period, and may be accounted for by several causes; firstly, no such work had been done before in British Guiana, and it was necessary to feel the way; secondly, it was experimental in the earlier stages, and work which might have been done in Areas A and C was delayed to watch the course of operations in B: thirdly, the slow and prolonged daily method of thymol administration was adopted in Area B; fourthly, the approximation of Area A to the city of George- town resulted in prolonging the time from January to March in order to trace and treat the few remaining persons in daily employment in the city. Subsequent experience shows that the whole campaign might have been completed in seven-eight

months.

12. No campaign against hookworm disease can ever be of much use without previous or coincident sanitary work. In this respect the International Health Commission has had the co-operation of the Government Public Health Department. In this sanitary work the International Health Commission took no part, save that of education, of advice, and of persuasion. The actual work was done by the Govern- ment Public Health Department through its officers. With the advice of Dr. Howard a special type of pit latrine, protected against flies, fowls, and animals, was adopted, and the villagers required to conform to this type. Over 1,000 new ones have been erected and some 600 improved. In the northern part of the district there are very few houses without such an adjunct, but in the southern half less success has been achieved, and it is there that houses are found unprovided. outbreak of the European War in August depleted the staff of the Public Health Department and has delayed the plans laid down.

The

13. Apart from the special provision of latrines, and apart from prosecutions for disposal of night soil otherwise, the district has profited by a general change for the better. The main and interlot drainage has been cleaned out, the screening of vats and barrels accomplished, the dense overhanging bush and unnecessary vegeta- tion cleared away. Many insanitary buildings have been removed, bakehouses and provision shops cleaned and reconstructed, accumulations of rubbish removed, and ventilation increased.

14. The villagers themselves, realizing the benefits accruing from work of this nature, have levied an additional rate to pay for a special Sanitary Inspector for the district, who has been at work since 1st November. 1914.

15. The International Health Commission set itself a problem replete with meticulous detail and surrounded with unknown difficulty when attempting to make a microscopical examination of every individual in the villages of the Peter's Hall District, and to treat all those found infected; that such success has attended their first attempt indicates a wonderful confidence and the willing co-operation of the villagers, and will remain a record of monumental patience and skilful tact on the part of the Supervising Medical Officer and of Dr. Ferguson.

I have, &c.

The Honourable

The Government Secretary.

K. S. WISE,

Surgeon-General.

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9. Difficulties other than microscopical ones are illustrated in the various tables: especially that of paragraph 21. The inhabitants of these villages come and go at will; thus 10-5 per cent. (1,091) were not traced or departed after the census, some seeking work, or planting short crops temporarily elsewhere, others drifting in and out of the large city near by. Some persons evaded treatment, others flatly refused and repulsed all offers, a certain number abandoned treatment after begun, others again drifted away during the 'period of treatment. In this way 5.4 per cent. (582) were lost. Some few were too weakly and diseased to bear the treatment. 4-6 per cent. (484) had to be abandoned when it became necessary to close the campaign on 31st March, 1915.

town resulted in prolonging the time from January to March in order to trace and treat the few remaining persons in daily employment in the city. Subsequent experience shows that the whole campaign might have been completed in seven-eight months.

The