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It cannot be too clearly understood, however, that provided that reasonable precautions are taken to prevent the constant re-infection of the labourers, the presence of a small number of ankylostomes, even in a large proportion of the popula- tion, may have no appreciable effect. Moreover, no elaborate sanitary appliances are necessary to guard against re-infection on a large scale. For example, latrine accommodation on estates is sufficiently subserved by a hole or trench cut in the ground, provided that the contents are covered with earth from time to time. If it is ensured that this accommodation will be used by the majority of the labourers, the fact that isolated cases of fouling of the soil cannot be prevented is not of material importance. The main point is to guard against the fouling of the soil in places where, from the condition of the soil and the presence of numbers of labourers, it is clear that danger is to be apprehended.

In these circumstances the Committee think that no hardship can be involved in compelling estate owners, local bodies, and private persons to take such reason- able precautions as experience has shown will minimize the constant drain on the resources of the community which the existing state of affairs involves.

The Committee therefore recommend, for the consideration of the Secretary of State, that:-

(1) Wherever necessary, laws should be enacted enforcing the provision on estates, and elsewhere where numbers of labourers are collected, of simple, inexpensive, but efficient latrines, in places appropriate both as regards the convenience of the labourers and the health of the public.

(2) A penalty should be imposed on persons found avoidably defecating in any place where contamination of the soil or water would be likely to cause risk of infection.

(3) Each Colony should be divided into convenient districts, in each of which should be appointed an Inspector responsible to the local authority, medical officer, or some other authority, who should be charged with the enforcement of sanitary regulations.

(4) *An Inspector-General should be appointed by the Secretary of State, his salary being divided amongst the Colonies concerned, whose duty it would be to supervise the measures taken for the eradication of anky- lostomiasis and to distribute advice and information. This appoint- ment to be purely temporary, at any rate in the first instance. (5) In all schools object lessons on ankylostomiasis should, as far as possible, be given. Leaflets containing simple information on the subject should be distributed periodically. The Committee consider that the pamph- let prepared by Dr. Nicholls, of the Leeward Islands, would form a suitable model.

(6) While the treatment for ankylostomiasis of the whole population is clearly impracticable, arrangements should be made for the distribution from convenient centres, such as schools, post offices, district nurse stations, &c., of anthelmintics at cost price, with simple directions for use. For this purpose beta-naphthol is the most suitable drug; thymol and other toxic anthelmintics being only used under medical super- vision.

II. R. COWELL,

28 October, 1908.

Secretary.

PATRICK MANSON.

J. S. HALDANE.

J. CADMAN.

H. J. READ.

G. GRINDLE.

* Mr. Grindle reserved his opinion on this recommendation, partly on the score of expense, and partly on constitutional grounds.

41400

SIR,

No. 84.

THE SECRETARY OF STATE to THE GOVERNORS.

(British Guiana. No. 301.)

(Jamaica. No. 418.)

(Leeward Islands: No. 342.)

(Trinidad. No. 330.)

(Windward Islands. No. 139.)

Downing Street, 17 December, 1903. I HAVE the honour to inform you that a Committee has been sitting at this Office to consider what measures could be recommended for the prevention of anky- lostomiasis in the Colonies affected by that disease.

2. This Committee has been presided over by Sir Patrick Manson, and has numbered amongst its members Professor J. S. Haldane, F.R.S., who some years ago was commissioned to report to the Home Secretary on the prevalence of ankylus- tomiasis in the Cornish mines.

3. Reports on the existence and treatment of ankylostomiasis have been obtained from a large number of Colonies, and have been laid before the Committee, who have also taken verbal evidence from a number of medical officers and others who have had experience of the disease.

4. I have now been furnished with a copy of the report of the Committee, and in this despatch I propose to summarize the conclusions at which I have arrived after perusing it.

5. Having considered the reports received from the several Colonies, with the observations of the Committee upon them, I recognize that the loss of labour caused by the prevalence of ankylostomiasis is very serious, and affects prejudicially not only the employers of labour but the community at large. Not only is there loss of life, direct and indirect, but also, through the invaliding of labourers, the charges for hospital and pauper expenditure are largely increased. This loss is, in my opinion, largely avoidable. Experience has shown that certain simple, well-understood, and inexpensive measures can be adopted, which, if properly carried out, will reduce the evil effects of ankylostomiasis to a negligible quantity,

6. I think that the Colonial authorities have been inclined to exaggerate the difficulties of dealing with this question. They have argued that the complete eradication of ankylostomiasis is impracticable, and that the cost of preven tive measures is prohibitive; and they have been content, with a few commendable exceptions, to do nothing in the matter.

7. It cannot be too clearly understood, however, that, provided that reasonable precautions are taken to prevent the constant re-infection of the labourers, the pre- sence of a small number of ankylostomes, even in a large proportion of the population, may have no appreciable effect. Moreover, no elaborate sanitary appliances are necessary to guard against re-infection on a large scale. For example, latrine accommodation on estates is, I am advised, sufficiently subserved by a hole or trench cut in the ground, provided that the contents are covered withearth from time to time. If it is ensured that this accommodation will be used by the majority of the labourers, the fact that isolated cases of fouling of the soil cannot be prevented is not of material importance. The main point is to guard against the fouling of the soil in places where, from the condition of the soil and the presence of numbers of labourers, it is clear that danger is to be apprehended.

8. In these circumstances I think that no hardship can be involved in compelling estate owners, local bodies, and private persons to take such reason- able precautions as experience has shown will minimize the constant drain on the resources of the community which the existing state of affairs involves.

9. I therefore recommend, for your very careful consideration, that:-

(a) Wherever necessary, laws should be enacted enforcing the provision on estates, and elsewhere where numbers of labourers are collected, of simple, inexpensive, but efficient, latrines, in places appropriate both as regards the convenience of the labourers and the health of the public.

(b) A penalty should be imposed on persons found avoidably defæcating in any place where contamination of the soil or water would be likely to cause risk of infection.

• Sue No. 83.