CO885-(18-19) — Page 634

PUBLIC RECORD OFFICE

Reference -

C.O.885

19 PUBLIC RECORD OFFICE, LONDON

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

15€

6. I trust that you will appreciate the advisability of giving these matters your attention.

I have, &c.,

CHAS. W. DOORLY,

Acting Protector of Immigrants.

Malvern, P.O., March 10, 1908. SIR,

I BEG to acknowledge receipt of extracts from a circular from Right Honour- able the Secretary of State for the Colonies on the subject of ankylostomiasis, asking for information and suggestion on remedial measures.

The history of the disease from the point of personal experience. This embraces a period of twenty-four years, seventeen in the Black River District-with a hospital attached, three years in the Port Maria District-also with a hospital, and four years in the Santa Cruz District-with an almshouse. By virtue of the institutions attached to these districts an idea was obtained of the prevailing diseases, and as the different districts were typical of dissimilar geographical conditions and labour conditions, the results are of special interest in this particular disease; thus the (1.) District of Black River, in the Parish of St. Elizabeth, contains a large area of swamp, a small area of what may be best described as watery land drained by sluggish streams and containing marshy ponds, and another large area of high lands with quick-flowing rivers or made ponds: in this district I first came across cases of ankylostomiasis in the second area-that of the watery land; the cases were few, and being still in touch with that district, I can say that the disease has not increased; here the labour is mostly of the hoe type, there is no stirring up of the soil by plough, fork or spade, and none but natural drainings; there is, therefore, no rapid flushing of rivers, and the streams are sluggish, drainage being by percolation rather than surface. The water remains free from mud and the disease appears to be localised in consequence.

In the swamp area an occasional but rare case occurred; in the mountain area I did not meet with any.

(2.) The District of Port Maria was characterised by its undulating nature, hills and valleys; unusually a rivulet in each valley subject to rapid flushing, when the water is liquid mud, and then drying off to a nice trickle from one semi-stagnant pool of water to the next, with the course of such rivulets blocked by the débris washed down by previous "spates."

The valleys are mostly banana cultivations; the soil a loose alluvial deposit (of sandy nature admixed with clay) extensively drained, and all drains debouching on the river courses.

The labour is all by plough, fork or spade, and therefore hands and feet become muddied. There are no swamps in this district.

On taking charge of the Port Maria District I found a much more serious condition existing, then, whilst a fairly large number of negro labourers suffered from the disease, it was prevalent amongst the coolies and on some estates was universal and virulent, but the disproportion amongst the classes affected was so great that no other explanation could be tenable than that afforded by the coolies always drinking water by making a gutter of the hand to mouth, pouring the water in the gutter thus made, and in so doing washed the eggs of the ankylostomes into their mouths.

There is absolutely no doubt that during the time of three years that I was District Medical Officer, Port Maria, the disease markedly increased, but I could' obtain no information from the previous records as no diagnosis of ankylostomiasis had been made in the hospital books; a few cases were classified as "Tropical Anæmic," and these I had no doubt had been cases of ankylostomiasis.

In the Port Maria District the main industry is banana cultivation, which means free and extensive drainage: these drains, opening on the streams, carry off the surface water and, without doubt, fæcal deposits in the banana fields, thereby constant inoculations of rivers occur; but the soil being of a clayey nature and reten- tive of moisture, I am of opinion the larvæ retain their vitality a longer period, and inoculation by way of the skin would account for a troublesome skin eruption on the legs of coolies.

(3.) The District of Santa Cruz is generally a very dry one; red-earth soil

157

and marl subsoil prevent the formation of marshy ponds, &c.; the cultivation is mainly corn (Indian), tobacco and grass (roots are cultivated in a dry area mostly); hence the earth is usually in a powdery condition and contamination of hands inconsiderable; it follows that in this district ankylostomiasis is almost unknown. I found one case in a child living in a mountainous district, which child proved to be an earth-cater. The water-supply in this district is by tank, pond, or well, a small arca by large deep streams not liable to surface pollution to the extent of rendering the waters very muddy.

In the course of my duties as Medical Officer for the Santa Cruz District cases come under my observation in the parochial almshouse, and the majority of the cases of ankylostomiasis are sent in from the Balaclava District, and mostly from a part of that district where the local conditions mostly correspond to that existing in the Port Maria District, only that here the rivers run from short distances and then sink gradually-tailing off to nothing, in fact, pass through natural filter beds; cultivation, cane and roots; soil clayey-retentive of moisture-and an abundant rainfall, with free natural surface drainage and rapid flushing of the rivers with muddy water-all the conditions, in fact, required for the propagation of the disease, combined with the prevalent practice of the labouring class to drink water from the streams by taking up the water to the mouth by the hand, which most often is soiled with the muddy earth in which they had been at work.

Coming to "particulars "-

(a) There are no sanitary measures in force in the Colony for dealing with

the disease.

(b) Latrine accommodation is entirely absent both on estates and in centres

of population apart from towns or villages.

(c) The treatment I adopted was the usual one of thymol followed by quinine

and large doses of perchloride of iron.

I found the treatment of the disease very disheartening, inasmuch as patients returned to the same local conditions and in a short time were as bad as before.

Suggestions for local measures.

1st. For the treatment on plantations.

My experience was rather discouraging. In about the year 1902 I drew up for the Inspector of Immigrants what I believed to be essential conditions for the benefit really of a large banana planter in St. Mary, who, whilst desirous of obtaining coolies on an estate professedly inoculated with the disease, would not adopt the necessary precautions to maintain such coolies in a healthy condition, my proposals were met with violent opposition, and I had to advise the Inspector of Immigrants that unless such recommendations were carried out no coolies should be located on the plantation. This was the net result of my attempt at reform.

I would now go further and insist that all coolie locations should-as far as local conditions render it possible- be constructed and maintained on the lines then laid down. These conditions are :-

(a) Coolie (or other labourers) barracks are not to be located on the banks of streams, and not on such a site that after rains the surface wash from such site finds its exit into any stream, pond, or other receptacle used in any part as drinking water.

(b) As far as may be possible all barracks used for the accommodation of labourers in districts where ankylostomiasis prevails should be located on a marl surface or a marl subsoil.

(c) The compound around barracks within a radius of one hundred yards to be kept free from undergrowth and drained where any pools of water tend to accumulate.

(d) All such barracks to be supplied with closets on the concrete trench and

cess-pool principle, and be periodically cleaned.

(e) The water-supply to be as may be possible protected from pollution: streams used as a water-supply to be kept free from obstructions tending to cause stagnation.

(f) Mud floors to be disallowed in all barracks-native or coolies; mark may be substituted, in which event renewal at least twice yearly is neces- sary; a wooden floor, elevated eighteen inches or two feet from the earth, which can be washed down, is best.

تر

FOLIO AccooD OFFICE Reference :-"

COPYRIGHT PHOTOGRAPH-NOT TO

KERKORLIZED PHOTOGRAPHIC-

3

!