PUBLIC RECORD OFFICE
Reference :---
PULCO 885
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24 PUBLIC RECORD OFFICE, LONDON
ALLY WITHOUT PERMISSION OF THE! BE REPRODUCED PHOTOGRAPHIC- COPYRIGHT PHOTOGRAPHINOT TO
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REPORT MADE BY DR. MARie, Assistant MEDICAL OFFICER OF PRASLIN DISTRICT. YOUR EXCELLENCY,
It will be easy to find some person who will undertake the night soil service at Rs. 2 per tub monthly. But it must not be forgotten that this is not a mere sani- tary measure, but one with a definite purpose, namely, to eradicate ankylostomiasis. I doubt that the system will meet with the same success as in Mahé, where it is under constant supervision, and the contractor has an interest in doing the thing thor- oughly, as the manure which he gets is another source of profit to him. If an indi- vidual or private concern can do the work at Rs. 2 per tub monthly with a profit, The service must be done almost could not the Government do it at the same cost?
to perfection if any good is to come out of it. It will be an experience entirely new to the inhabitants, and I am afraid the contractor may show slackness if he meets with opposition at all or any difficulties arising [out] of the new conditions.
It will be safer, and far better results can be expected, if the work is done by the Government. I do not say that a contractor will not be able to do the work in the future, but the Government must begin, and the established rules and practices will be a guide to the future contractor. As to the collecting pit, it must not be situated in the plateau, but at some selected spot on the hill. The Government will have to purchase a site for this.
In the meantime, I think we should wait for the arrival of Dr. Heiser before starting anything. His wide experience will guide us in the working out of the details of the whole scheme, and after he will have become acquainted with the local conditions he will likely make many suggestions.
G. J. MARIE,
29th May, 1915.
YOUR EXCELLENCY,
Assistant Medical Officer.
REPORT ON ANKYLOSTOMIASIS.
I HAVE the honour to forward my report on the prevalence of ankylostomiasis
in the Praslin and La Digue Districts.
It did not take me long to notice the harm that is being done by the spreading
of the disease, both from an economical and social point of view.
Praslin. Taking Praslin first, it is evident that only a small percentage of the population suffers from this disease. This is undoubtedly due to the better sanitary conditions prevailing in Praslin. As a rule, the houses are far apart, and there are as many people who live on the hills as on the plateaux.
The disease is not so common in those living on the hills, owing to the better drainage of rain-water, the soil being always dry. The people living in the plateau of Grande Anse suffer more from this disease than those living at other parts of Praslin.
La Digue.-La Digue is the island which harbours the largest number of cases. I may say that fully 50 per cent. of the inhabitants show definite signs of the disease; a great number, though showing no external sign of the disease, may possibly be infected. I would not be surprised if a systematic examination of all the inhabi- tants should reveal a degree of infection amounting to 90 per cent. of the whole population.
The people are aware that anæmia is widespread among them, but few of them know the real cause of the anæmia.
All the conditions which favour the existence and development of the larvae are found in La Digue.
Most of the inhabitants live on the plateau, a few live on the hills. Whenever there is a heavy rain fall most of the plateau is flooded, the water It often remains stagnant, and as it is slowly dried up the soil is always moist. happens that the houses are surrounded by pools of water through which the occupiers going outside have to walk, sometimes knee deep. There are places where stagnant water is always found, sheltered by dense foliage and jungle, which prevent the effective penetration of the sun's rays. Most of the inhabitants are accustomed to walk barefooted, especially at night.
Even well-to-do people do this. Thus they become an easy prey to the larvæ, which usually enter the body through the skin of the foot.
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The other factor directly concerned with the prevalence of the disease is the insanitary habit, which prevails among the inhabitants, of answering the call of nature anywhere they think fit.
near by.
The proximity of dwelling houses is to them no objection. Mothers are in the habit of emptying the vessels containing the excreta of their children in the wood The result is that the first rain washes down the excreta, and, as the plateau is easily flooded, the ova or larvæ are thus disseminated broadcast, so that every part of the plateau may be considered infected. For the complete eradication of this It is abso- disease I will mention the various measures which would be adopted.
lutely necessary to educate both the poor and the rich of the district in the nature of the disease and in the means to be employed to fight it. The co-operation of the inhabitants is essential; to ignore that would be a great mistake, for it will lead to a misunderstanding. No amount of legislation could ensure a success unless the good will of the inhabitants is first secured.
The
(1) A series of lectures, with lantern slides, in French could be delivered from time to time, so that the people may understand the aim of the measures to be adopted.
(2.) The removal and disposal of excreta is a difficult problem to solve. erection of public latrines may be helpful, but by itself it cannot do much good.
It will be necessary to enforce by legislation that every house be provided with a latrine.
In the case of hill-dwellers pit latrines will do, but in the case of plateau- dwellers bucket latrines are best.
Pit latrines cannot be used in the plateau, on account of flooding. The buckets must be removed periodically and their contents burnt. A cheap incinerator could be built for the purpose
I do not think it advisable that the contents should be thrown into the sea. It must not be forgotten that the inhabitants are great fish- eaters, and the contamination by fish is still an open question.
Besides, the excreta will be carried back to the shore and thus cause a nuisance, unless they are thrown far out at sea. I think this will prove in the end more expensive than an incinerator. These measures should be carried out by Govern- ment, and their cost redeemable from the owners of properties by annuities, as is done for the drainage in Mauritius.
(3.) The measure recommended in paragraph 2 of the local Committee's report should be adopted in extenso.
I have indicated broadly the measures that must be adopted; the details could
be worked out after the arrival of the representative of the International Health Commission.
There is a real and urgent need of steps being taken to prevent the spread of the disease.
paratively short time.
27th April, 1915.
YOUR EXCELLENCY,
I am confident that we could get rid of this disease in a com-
G. J. MARIE, M.B., Ch.B. (Edin.),
Assistant Medical Officer.
I HAVE read Dr. Marie's report, and I agree with all he says on the subject. Dr. Marie is perfectly right in pointing out that the educational factor is of the greatest importance. In fact, could the population of La Digue once be impressed with the nature of the disease and the necessary precautions to be taken and per- suaded to act thereon the battle would be half won, but the difficulty of so impress- ing the population is enormous. Every Medical Officer who has been working at La Digue of late years has been spending considerable pains in disseminating know- ledge on the subject, but the population is indifferent and only take a very superficial interest, and will not act on what they are told. In my opinion there is only one measure that will have any effect, and that is strict legislation carried out to the letter.
J. B. ADDISON,
Chief Medical Officer.
11th May, 1915.