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The reasons for suen treatment should be explained to the immigrants by the Government medical officers and sick nurses, and demonstrations given of the presence of the worms in stools, and the evil results of allowing the worms to remain in the body.

2.

Treatment "en masse.”—Cards explaining the disease, its course, and the ill-effects resulting from neglect of its treatment, should be published, similar to the cards relating to tuberculosis and malarial fever. These cards should be freely distributed to the villagers and gold-diggers.

Every opportunity should be taken to treat any cases when met with.

3. General and special sanitary measures.-Anchylostomiasis could be blotted out of existence by the sole means of a proper disposal of the faces. It is the fæces alone which are responsible for the spread of the disease. It is a disease conveyed from one human being to another solely by the agency of human beings themselves through dirty and careless habits. It is not a disease that requires the agency of any other animals to aid in its propagation. Therefore, if sufficient means are taken to dispose of the fæces immediately after they have left the body, in such a manner that human beings cannot again come in contact, or be contaminated with them, anchylostomiasis of a necessity must cease to exist.

Unfortunately this is by no means so easy of application in this Colony. Your returns conclusively prove that every shipload of immigrants arriving here brings numerous foci capable of spreading the disease.

It is obvious, therefore, that the disease will never be stamped out until these new immigrants are controlled, or until you have established a perfect system of disposal of fæces in the Colony. These immigrants, therefore, should be under An examination of control from the moment they are selected for embarkation. every one of them should be made at the start. Then all those who are found to be infected should be kept under treatment and observation during the whole of the voyage.

On their arrival in this Colony, every one of them should be again examined as soon after landing as possible, and on no account should any immigrant be allotted to an estate until his or her stools have been pronounced free from infection. I am convinced that these measures could be perfectly easily carried out. There may not be a sufficient number of medical officers to personally do this work, but other officials connected with the Immigration Department could Le trained to give very material assistance.

The same searching scrutiny of these immigrants should be carried out by the Government medical officers of the plantations on their arrival at the various

estates.

With regard to the proper disposal of the fæces, the matter becomes far more complicated.

On the plantations the ideal way would be to insist on latrines being built within easy access of every range on the estate. To insist on these measures, laws would have to be passed and means taken to see that these laws were rigidly carried

out.

On those plantations where latrines are difficult of erection, certain plots of land within easy reach of each range should be fenced in, and within these plots a series of shallow (not deep) trenches could be dug in rotation, i.e., so soon as one is filled in another could be dug and so on.

These sanitary arrangements should all be carried out under the supervision of the Government medical officers, and a driver or headman should be placed in charge of each latrine or series of trenches to persuade and insist on the immigrants making use of them. It should be a crime punishable by law for anyone to defæcate elsewhere than the allotted latrines or trenches.

Until laws are passed on lines such as these, I am convinced that the latrine method will only be half-heartedly carried out on the majority of estates.

With regard to the villages, the local boards should insist on each dwelling- house possessing its own latrine, and a proper inspection and supervision of the disposal of the contents would have to be instituted.

I am quite sure that every one of these measures is capable of being carried out; that there need be but little additional expenditure involved; and that should these

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measures or similar ones ever he instituted, anchylostomiasis will be a negligible quantity in the mortality, sickness rate,, and hopeless invaliding of the labouring class in this Colony.

A. T. ÖzzARD.

II.

REPORT by Dr. W. J. Vox WINCKLER Fe the Treatment of Anchylostomiasis on (1) Plantations; (2) "En Masse": and the General and Special Sanitary Measures.

Peter's Hall Medical District.

28 January, 1908.

HONOURABLE SURGEON-GENERAL.

Is further replying to circular minute, 2143/07, I beg to submit the following:-

(1) Local measures for anchylostomiasis on plantations.-At the outset the diffi- enity of having a common system presents itself, as measures suitable for some are unfeasible and unworkable on others.

(A) Latrine jetties answer well on river plantations where ranges are near the river, as on East Bank and West Bank, Demerara.

The system of latrines over drains near ranges, as at Providence, East Bank, could be considerably improved on if drains were concreted and flushed as at present. As now prevails these drains must be cleaned and dug and fæcal matter deposited on sides and near ranges and, therefore, throwing up fresh foci of infec tion. A system of concrete drains laid with self-cleansing gradients and flushed and discharging into main drainage of plantations, or a pit dug to receive sewage might prove the best system available in districts such as East Coast and West Coast,

Demerara.

(1) Water supply.-The constant and easy fouling of the open water supply by Amigrants and villagers and in most cases even unprotected, requires attention. I believe this remark applies with equal force to nearly every estate, except l'eter's Hall and Blairmont, which have a protected water supply. The remedy is to have a protected water supply, as the water supply on most estates (on East Bank and West Bank) is fouled and non-protected.

Weeding yards. This, to my mind, is an important and too often neglected measure, although a statutory obligation on indentured plantations; doubly so on free estates. The long grass keeps ground wet about ranges and children and even immigrants soil earth and must keep up infection, as manifested in ground itch. lluring wet weather.

Treatment at houses. For the past three months I have prevailed, with con- siderable success, on immigrants and others resident on estates; to submit to treat- ment at their own houses if unwilling to be treated in hospital. This I have not the least doubt will considerably lessen the prevalence of anchylostomum duodenale on estates, but will depend a good deal on the energy of the district medical officers and dispensers in carrying it out.

2. Anchylostomiasis en_masse."--In this Colony, so sparsely populated and distributed over such a vast area, treatment must be difficult and unsatisfactory, apart from the serious question of cost involved. Dispensers in outlying districts night he instructed to treat ordinary cases and to teach elementary sanitary measures. This could also be done by placer owners, managers on mines, &c., and cards (such as cireulated about mosquitos) about dangers and result of anchy- lostomum duodenale infection circulated.

General and special sanitary measures.—I submit, as my honest opinion, that if the Government Bacteriologist be given a roving commission all over the Colony, to visit mines, grants, Indian settlements, &c., to find out where anchylostomiasis occurs, and I think it will be found everywhere, most valuable information would be gained and appropriate measures adopted then. At the same time the incidence of malaria, filaria, and other tropical ailments could be enquired into by the Govern- ment Pathologist.

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PUBLIC RECORD OFFICE

Reference :-

C.O.885

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