CO885-(18-19) — Page 629

PUBLIC RECORD OFFICE

6

Reference :--

TIC.O.885

19 PUBLIC RECORD OFFICE, LONDON

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

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give below a statement of the admissions and deaths, under the heading "Anchylos- tomiasis," in all hospitals during the last 10 years:—

Year.

Deaths.

Admissions.

1,257

234

1,330

273

1.691

326

1.609

257

1,375

272

1,37

286

2,601

516

3,206 3,631

788

858

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9. As an object lesson, I beg to refer you to my report on my visit to Manila, and to the manner in which the medical authorities there stamped out worm discases among 4,000 prisoners, 90 per cent, of whom had anchylostomiasis, and so reduced the death-rate from 200 per 1,000 per year to 12.

A. PERRY,

Principal Civil Medical Officer and Inspector-General of Hospitals.

1899

19:00

1901

142

1903

1901

1903

1906 1907

The above table shows that this disease is making rapid headway on estates in this island, and that it is spreading to the Singhalese villages on the confines of estates.

5. Its distribution. This disease is prevalent in this island wherever the immigrant Tamil coolie lives, in other words, the coolies on the tea and rubber A large portion of the coolies who arrive here from estates are largely affected.

If Ceylon is divided into the " "Dry India are already infected with this worm. and “Wet "Zones, they represent, respectively, those parts of the island slightly and markedly infected with anchylostomiasis. They also represent the non-planting (non-immigrant Tamil) and the planting districts (immigrant Tamil). The fol lowing Provinces are either not infected with this disease or very slightly so:- Eastern Province, North Central Province, Northern Province, parts of North- Western Province, parts of Uva, and parts of Southern Province.

The following Provinces are badly infected:-Central Province, Western Province, Sabaragamuwa Province, and parts of 'va, parts of Southern Province, and parts of North-Western Province. In short, the planting districts are the wet ones, and where these meteorological conditions exist there the disease flourishes. There is very little immigrant Tamil labour in the dry zone. I am not in a position to say that this zone would remain comparatively free from the disease if immigrant Tamil coolies settled down there.

6. Marked increase in the severity of the discase during the rainy season has not been noticed in Ceylon, but the admissions to hospitals for all discases is higher during the wet months, and many of the patients suffer from anchylostomiasis or its complications.

7-(a) There are no sanitary measures in force in Ceylon for dealing with this disease. I beg to refer you to paragraph 2 of the Report on Sanitation of Estates, above referred to,

In the towns which come

(b) There is no latrine accommodation on estates. under Municipalities, Local Boards, and the Small Towns Ordinance, public latrines are provided, and the "dry carth" system is in use, the contents of the bucket are removed and buried, sanitary inspectors supervise the conservancy;

(c) Thymol is considered here to be the best drug, although on Sir Patrick Manson's suggestion we gave eucalyptus oil an extensive trial." Beta-naphthol is preferred by some medical officers. All are agreed that a long course of iron tonics is necessary after the worms have been got rid of.

8.-(1) For the preventive treatment of anchylostomiasis on plantations, I have little to add to the report on the Sanitation of Estates Committee, except that I would make the use of proper latrines and a pure-water supply compulsory.

(2) For the treatment of anchylostomiasis en masse, the public can now be treated at all Government hospitals and dispensaries, but patients ought really to be in hospital so that the effect of the remedy can be watched and the excreta examined microscopically. To do this effectively, the hospital accommodation will have to be considerably increased and the staff strengthened.

(3) General and special sanitary measures-to educate the people to observe cleanliness and to teach them the dangers of becoming infected with this disease. To largely increase the public latrine accommodation in small towns and villages, to improve the drainage, and to supply a pure water. As a special sanitary measure it would be possible to rid every immigrant of his worms on arrival, if the planting community would bear the expense of his stay in the Coolie Camp and the extra medical staff that would be required.

Enclosure "B" in No. 72.

THE DISEASE ANCHYLOSTOMIASIS, OR DOCHMIUS DUODENALIS.

The cause of this disease, which is very prevalent in the planting districts, is

a small intestinal worm; its spread is due to want of proper sanitation.

The eggs of the worm, or the recently hatched worms themselves, gain an entrance to the human subject either by the skin, or are swallowed.

The disease is spread by soil or water contaminated by the excreta of persons suffering from the disease.

The measures to be enforced to check the spread of this disease fall under four heads:-

(1) The

proper disposal of night soil (exereta).

(2) Protection of the legs and feet.

(3) Pure water for drinking and washing purposes.

(4) The segregation of all cases in hospital until cured.

Under the first head it is necessary for Superintendents to prohibit_coolies from fouling the soil indiscriminately, and to carry out this prohibition latrines should be built on every estate, and coolies who do not make use of them should be punished. The night soil should be collected in buckets and buried daily in a part of the estate away from dwellings and water-courses.

Under the second head means should be employed to protect the legs and feet of coolies, for the worms which are in the polluted soil find their way into the system through the skin, and are often the cause of ulcers, so commonly seen on coolies' legs. A cheap form of boot worn outside putties would afford protection; in some countries tar covered with sand is applied to the feet and legs.

Under the third head at present water-courses and bathing places are con- taminated by the surface drainage of the soil being washed into the water after rain; means should be taken to see that this cannot happen. The water used by coolies for cleaning themselves, after a call of nature, should not be allowed to run into the drinking or bathing supply.

Under the fourth head it is quite impossible to admit every cooly with anchylostomiasis into hospital and to keep him there until cured, because the disease exists in nearly every cooly on every estate, and the hospital accommodation is insufficient for them; but as far as possible coolies will be admitted and retained in hospital until they are cured, and will be put under a new treatment that has recently been introduced into the island. (Medical officers will refer to Circular Letter to Provincial Surgeons of the 27th June, 1906.)

As long as the present insanitary condition as regards disposal of sewage, &c., on estates continues, there is little encouragement for medical officers to cope with this disease, because, when cured, patients get re-infected on the estates soon after their discharge from hospital, and the whole business has to be gone through again ad infinitum.

The above remarks will be met by the statement that the suggestions are totally impracticable of being carried out; the answer to which is, that they are not impracticable provided those in charge of estates will spend a little money to improve the condition of their coolies. The return for the expenditure will be a more efficient labour force,

Colombo, 29 September, 1906.

ALLAN PERRY, Prineipal Civil Medical Officer and Inspector-General of Hospitals.

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