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(c) 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 sanitáry regulations.

(d) 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.

(e) 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-napthol is the most suitable drug; thymol and other toxic anthelmintics being only used under medical super- vision.

10. It has further been suggested that an Inspector-General should be appointed, his salary being divided amongst the several Colonies concerned, whose duty it would be to supervise the measures taken for the eradication of ankylosto- miasis, and to distribute advice and information. The appointment would, it is suggested, be purely temporary in the first instance. While I shall be glad if you will place this suggestion before the Legislature, if a convenient opportunity should occur, and invite their observations upon it, I wish it to be clearly understood that discussion of this proposal should not be allowed to interfere with the carrying out of the measures which I have advocated above. The appointment of such an officer would, I recognise, involve financial and constitutional questions of some complexity; and I do not wish that the execution of the more immediately practicable measures for the eradication of ankylostomiasis should be deferred pending the discussion of these questions.

11. I enclose a short memorandum in which the reports received from the several Colonies concerned were summarized for the purposes of the Committee. Should you desire to obtain further information in regard to any of the measures referred to in this memorandum, I shall be glad to supply you with a copy of any particular report.

12. I request that you will inform me in due course what additional measures for the prevention of ankylostomiasis you propose to take in pursuance of the recommendations made in this despatch, and that you will include annually in the Medical Report some account of the progress of those measures.

13. A despatch in identical terms is being addressed to the Governors of the West Indian Colonies with the exception of those in which the disease is reported to

be unknown.

Enclosure in No. 84.

I have, &c.,

CREWE

SUMMARY OF THE REPORTS RECEIVED FROM THE WEST INDIAN COLONIES ON THE SUBJECT OF ANKYLOSTOMIASIS.

BAHAMAS.-In this Colony the disease is said to be practically unknown. BERMUDA. This Colony is also said to be free.

BRITISH GULANA.-The disease is very prevalent, no less than 39,000 cases having been treated in the estates hospitals in the last four years. There are no special sanitary measures legally enforceable for dealing with the disease. The Medical Department have had to rely on persuasive measures; but much has been done, especially on the sugar estates, 23 of which, or nearly 50 per cent., have been induced to provide proper latrine accommodation for labourers. In the village and country districts the latrine accommodation is very unsatisfactory, but in the opinion of the Surgeon-General the matter is not so important there as on the sugar estates. The village councils, under the guidance of the Local Government Board, are making every effort to improve the sanitary condition generally, so far as their finances allow. The Surgeon-General has recommended the enactment of legislation to compel owners to provide proper accommodation on estates; but the Governor wishes to postpone action in view of the precarious financial condition of

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the estates. The Secretary of State has suggested to him that it might in any case be possible to make the allotment of new indentured labourers to an estate condi- tional on the provision of satisfactory sanitary arrangements.* The treatment of individuals with thymol, beta-napthol, or eucalyptus appears to be well under- stood, medical officers using one or other of these drugs according to individual preference.

A

JAMAICA. Ankylostomiasis is prevalent in certain districts, especially among the Indian labourers. No sanitary measures have been enforced on estates. circular, advocating the provision of latrine accommodation, was sent to estate owners some years ago, but although something was done on a few estates, there was a difficulty in compelling the coolies to use the latrines, and no serious effort was made by employers to carry out the suggestions of the Government. Treat- ment with thymol appears to be general in Jamaica. The Governor proposes to consider amendments of the law to give the Medical and Immigration Depart- ments power to enforce sanitary regulations. The general opinion of the medical officers is that the treatment of the population en masse is impracticable, and stress is mainly laid on sanitary measures. Notification of cases is recommended. The conditions in the villages seem to be fairly satisfactory.

LEEWARD ISLANDS.-Ankylostomiasis is not prevalent except perhaps in Antigua. No sanitary measures are enforced. No special measures are considered necessary, beyond the erection of additional latrines in centres of population. Individual case. have been treated with thymol.

TRINIDAD. No special report has been received. The Factory Ordinance, now under consideration, contains a clause enforcing the provision and use of suitable sanitary accommodation wherever groups of ten or more persons are employed on a sugar estate, the accommodation to be within 100 yards of the place where the persons are employed, and imposes a penalty on the misuse of such accommodation. WINDWARD ISLANDS.-It is estimated that two-thirds of the labouring popula- tion in St. Vincent are infected. No sanitary measures are in force, and no latrine accommodation exists on estates, while that in the villages is inadequate. The Administrator of St. Vincent expresses the opinion that no successful campaign against ankylostomiasis is possible without a much more numerous and efficient medical staff. The medical officer of Kingstown suggests, besides the usual sanitary measures, the supply of drugs and microscopes to medical officers. In St. Lucia the disease is very prevalent. The Administrator thinks that the Board of Health have powers to enforce sanitary measures at all factories and estates; but for this purpose funds would be required for inspection. No sanitary measures are, in fact, in force, and no latrine accommodation exists on estates. The villages are better provided in this respect. The medical officers regard treatment en masse as im- possible. They recommend the instruction of the school children in simple sanitary rules. The Administrator suggested that some part of the cost of treatment of labourers should be thrown on employers, but the Governor appeared to think this impracticable. In Grenada ankylostomiasis has not reached very serious propor- tions. The Governor doubts the efficacy of any sanitary measures, since the labourers are not employed in large numbers on estates, are constantly moving from place to place, and are consequently very difficult to control in sanitary matters. Something might be done by persistent teaching in the schools, but he was not optimistic. The Secretary of State drew the Governor's attention to the allegation that the schools were not provided with adequate latrines, and asked that the matter might be looked into.

TREATMENT ON BOARD THE COOLIE SHIPS.-Dr. Fonceca, Surgeon-Superintendent of the coolie ship "Mersey," has forwarded a report of the treatment of the coolies under his charge. With few exceptions every adult was treated with beta-napthol. There were no objectors.

No immediate benefit was noticeable, and out of 45 selected cases treated, five were still found to be infected. Nevertheless, Dr. Fonceca advocates the treatment, which is simple, inexpensive, and easily carried out. There would not, however, be time for the treatment to be carried out on steamers, and it should be noted that steamers are being substituted for sailing vessels, and are indeed recommended as more healthy. At a meeting of Surgeons Super- intendent it was resolved that it was undesirable to make the treatment compulsory,

The Governor has now issued a circular to estate owners warning them that the allotment of immigrants in future years may be made conditional on the provision of suitable latrine accommo-

dation.

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the reasons given being the impossibility of carrying out the treatment on a voyage of ordinary length, or one on which epidemic disease occurs, and the other pressing duties of the surgeon. They considered that the treatment described by Dr. Fonceca had been a failure.

14 October, 1908.

H. R..C.

NOTE. Since the above memorandum was written a despatch has been received from the Officer Administering the Government of Trinidad, from which it appears that the Legislature will shortly be invited to deal with the question of sanitary accommodation on estates and in the larger centres of population. The Surgeon- General has arranged with the majority of estates proprietors to provide at their hospitals small microscopes and other apparatus.

Dr. A. Harrison reports that he carried out a simple course of treatment on the steamship "Mutlah" in the routine manner recommended by Dr. Fonceca. No objection was raised by any emigrant. No appreciable improvement in the condition of the emigrants could be observed.

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