CO885-(18-19) — Page 615

PUBLIC RECORD OFFICE

Reference :-

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19 PUBLIC RECORD OFFICE, LONDON

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ing the water. Until one had made himself familiar by long work with the appear- ance of the particular larva, such an examination was felt to be futile, as so many nematode larvæ may be present in soil and foul water. It is well established, and I have satisfied myself by experiment on a monkey, that hook-worms in the intestine can be acquired by ingestion of the larvæ.

The measures for the prevention of hook-worm disease fall into two groups :- (1) The attempt to suppress or diminish the existing human infection. (2) The attempt to prevent new infections-

(a) By avoiding the pollution of the soil and water. (b) By guarding individuals from infection.

Of these the first is to my mind the more important and easier. The measures of the second group are necessary, but will be unavailing in the absence of the first. No doubt a person of the better class avoids getting hook-worms, and that too unconsciously. lle wears boots, he does not work in mud, he has not to depend on a water hole for drink. But to the peasant all these conditions are different. He cannot even, if taught,,entirely avoid infection, where the sources of infection so encompass him. The majority even of educated persons, while admitting the truth of hygienic recommendations, are careless or find the personal precautions irksome, inconvenient, difficult, or sometimes impossible.

Some good will be done by teaching the peasants. In the Primer of Tropical Hygiene used in the schools in St. Vincent, I have given attention to hook-worm disease, from the point of view of personal hygiene. In that section, and in the But mere knowledge section on water all the necessary teaching is included.

cannot protect the labourer while his circumstances remain unchanged.

It is impracticable to supply an unimpeachable water to a rural population, and the peasants will always use the nearest water, whatever it may be, rather than go Where there are large collections of indentured some distance for a purer supply. labourers, no doubt the proprietors should properly and legally be compelled to furnish a wholesome water. For all considerable villages the Government should aim at obtaining a public water supply.

Indentured labourers can be compelled to protect their legs with a coating of Barbados tar and sand, as suggested by Manson, when they are to work in muddy field and drainage ditches. The proprietors may be made responsible for this as long as infection could be considered to exist on a plantation.

To prevent pollution of the soil is only partially feasible. The labourer at his work, and his children at any time, will defecate in the open. The provision of numerous latrines in villages and on plantations will, however, very greatly lessen this soil pollution. Such latrines must be properly constructed and supervised, with due regard to other requirements of public health. The disposal of the excreta will have to be carefully considered and arranged. In this relation Government action in providing village latrines, legislation for estates, especially such as have inden- tured labourers, and rigid enforcement of existing police regulations anent nuisances and indecency will be called for.

But the first group of measures is the more important and perhaps more feasible, namely, those aimed at the treatment of existing disease and diminution of the number of disease carriers.

Indentured labourers are easily dealt with. They can be all examined periodi- cally and treated. It will not be possible to impose a compulsory treatment on free peasants. The thymol treatment is, moreover, often somewhat unpleasant. This will be overcome by the use of eucalyptol. The district medical officers can do much by the use of the microscope in as many cases as possible. It is certainly time that every medical officer in the Colonies should possess and use a microscope. In some parts, however, medical officers get a small salary; and it is difficult to conceive that a use of scientific methods and acquisition of special knowledge and skill can at all help a medical man in the Colonies to better his financial position or prospects. In other words, a microscope and scientific work are only intellectual luxuries to the Colonial medical officer. They are expensive luxuries, and if a man has no personal desire to undertake such expense he cannot be blamed. Only the community and the service can benefit by the scientific work of the medical man, not himself. I therefore suggest that every medical officer should be encouraged to use a microscope by being supplied with a good instrument for the use of his office. In St. Vincent the Veterinary Surgeon and the Agricultural School are

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supplied with good instruments, while the hospital has only a cheap little instru- ment. All the hospital work is done with my own microscope.

Medical officers, by systematic examination of as many patients as possible and treatment of all infected persons with eucalyptol can effect an important reduction in the bulk of infection. The Government must supply the drugs for this purpose, over and above the regular drug allowance, to be distributed free. The mixture of eucalyptol, santonin powders, and quinine can be kept at the prescribed stations where the medical officers attend, in order that the people may get them without loss of time and labour. The peasants are sometimes deterred from obtaining medicines, unless the case is urgent, by the distance they must travel to the dispensary.

Small microscopes must be kept at the prescribed stations to enable the medical officers immediately to diagnose the infections with worms, besides a better instru- ment to be kept at the medical officer's residence or office. Dispensers, hospital assistants, and intelligent attendants may be trained to perform the microscopic examinations under the supervision of the medical officer. In time the medical officers will, no doubt, apply these instruments to the diagnosis of malaria. They can carry with them the oil immersion lens and use it on the small microscopes.

The practical recommendations I desire to make are:-

(1) Supply of good microscopes to the medical officers, and cheaper instru-

ments to Le kept at the prescribed stations.

(2) Supply of the requisites for eucalyptol mixture and citrate of iron and ammonia to the medical officers without restriction as to quantity. The cheerful co-operation of the medical officers has to be secured, and vexatious and irksome reports must not be demanded.

(3) Provision of properly constructed and sufficient latrines, with latrinists

responsible for their management-

(a) By the Government in villages.

(b), By plantations at the factories and in the quarters for

indentured labourers.

In this relation I may mention that the mere keeping of fæces in water-tight cesspits will destroy the anchylostoma infectivity, for the maggots of flies digest the eggs and larvæ of these, though not of all, worms; and the larvæ of hook-worms will not live long in such pits. But regard must be had to the possible transmission of other diseases from fæces by flies, cockroaches, &c.

(4) Supply of wholesome water-

(5)

(6)

(a) To villages by the Government where possible. (b) By plantations to indentured labourers. Prosecution of persons for nuisances.

Appointment of rural sanitary inspectors with the authority of constables and attached to the police force, but instructed to take direction and advice from the medical officers.

(7) Abolition by filling or drainage of water holes declared by the medical officer to be insanitary. This, however, must be done with circum- spection, so as not to cause deprivation of supply or undue inconvenience.

(8) Compulsory examination and treatment periodically of indentured

labourers at the expense of their employers.

I wish it to be understood that I do not put forward these recommendations as necessary, advisable, or feasible for adoption in all tropical communities. They represent what I consider a complete scheme for dealing with hook-worm disease in West Indian Colonies. The degree of thoroughness to be attempted must be deter- mined by the conditions and necessities of each locality.

If it is decided to make any move in this matter in St. Vincent, it will give me great satisfaction to advise the local executive.

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C. W. BRANCH, M.B., C.M., Edin.. Medical Officer, Kingstown District, St. Vincent.

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