CO885-(20-21) — Page 544

PUBLIC RECORD OFFICE

Reference :-

TLC.O. 8

885

21 PUBLIC RECORD OFFICE, LONDON

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

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10. Amongst the chief reasons which led the surgeons to report against this proposal were:--

(a) Its being compulsory.

Dr. Law in his minute states that dictating to the surgeons in regard to medical treatment would be dangerous and objectionable.

(b) That there would not be time to apply it on steamers.

Mr. Duff, in the first paragraph of his minute, shows that he recognises that the surgeons have grounds for their opinion. Dr. Fonceca also recognises that it would be impossible to give a double course of the treatment on steamers, yet he stated that a double course would be necessary. He also regarded it as inadvisable to begin the treatment until after the people had recovered from sea-sickness and become accustomed to their new surroundings. He stated that he himself did not commence the treatment until he had been a month at sea.

(c) That it had not proved efficient.

The statistics given in the Agent-General's minute are, for the year 1908, as follows:

Description.

Name.

No. of times treated.

N. 8.

"Motlah"

Steamer Steamor Sailer Steamer

"Sutlej "Ems " "Ganges"

All once... None

All

Harrison

Miley, ill Fonceca

306 examined, 194 | Oliver

treated.

Percentage of cases found on arrival on estate.

73 per cent.

2633

67

"

55

"

55

11

These figures show that from one ship in which all coolies had been treated, 73 per cent. were found infected after arrival; that is, 6 per cent. more than from a ship in which no one had been treated. Again, the average percentage of the three ships in which all or most had been treated, was 61; that is, only 6 per cent. less than the one in which no one had been treated. Further, the "Ganges," in which 194 only were treated once, showed results equal to those ex Ems," in which all had been treated to the full double course by Dr. Fonceca himself. These results can scarcely be regarded as proof of efficiency. It is to be remembered that one of the three ships was the Ems," a sailing ship making a long voyage, and that her surgeon was Dr. Fonceca, who first adopted the routine method on coolie ships, and who, being on his mettle to prove his case, would naturally have been keen to carry it out thoroughly.

11. Dr. Law evidently does not think the method satisfactory, inasmuch as the course which he recommends in his minute differs essentially from it.

12. Dr. Law suggests that if the surgeons had been through a School of Tropical Medicine or had practised on shore in the tropics, they would have formed a different opinion; but, of the surgeons who took part in the discussions, at least two had attended the School of Tropical Medicine and three had had years of practice in the tropics on Government staffs. Each and all of these fully agreed with the opinion at which the mecting arrived.

13. As stated before, the general aspect of ankylostomes and their treatment were not involved only the question whether a certain specified course should be enforced on coolie ships. Therefore, it would seem that of far greater value than the school course or shore practice would be personal experience and knowledge of the special conditions prevalent on these ships. The surgeons are the only officially responsible body who have such experience and knowledge, and they had hoped that, on that account at least, their opinion would have had weight with the Govern- ment of British Guiana.

14. No mere knowledge of the rules laid down by the Government of India for the guidance of the surgeon can give any adequate idea of the amount of practical work he has to do in order to get the coolies and their quarters into good order and to maintain them so during the voyage.

15. The conditions on ship and on shore differ so much that data obtained on the one are very often useless in estimating for results on the other.

16. The following will show how great the difference is in some ways:—

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After a voyage of five or six weeks, during which they have, as a rule, greatly im- proved mentally and physically and have got used to a fair amount of disciplined routine, 800 coolies are landed in the Colony, and in the depôt there are divided, for the purpose of allotment to the various estates, into batches of, probably, from 10 to 40 people in each. Taking a batch of even the higher number as being sent to an estate-On this estate there will be some hundreds of coolies the whole routine of whose life has been going on for years. There is a hospital separated from the living quarters and from the working places, a district surgeon whose duties on the estate are solely medical, a compounder in the hospital whose duties are solely medical, and there are, as sirdars or headmen, intelligent coolies who have been long accustomed to the routine in vogue to understand orders and to carry them out promptly and efficiently. It is, of course, not difficult to absorb 40 new coolies into this routine and to apply to them such a course of treatment as that suggested by Dr. Law.

If, in contrast, we suppose 800 ignorant coolies to be transferred directly and in one batch from the Calcutta depôt to an estate in British Guiana on which there are no other coolies, where the only accommodation is a one-roomed building within the walls, and on the roof of which the whole daily life of these 800 people has to be lived, where the only staff is a surgeon with 3 more or less competent compounders, where sirdars are chosen of necessity almost at haphazard from amongst this ignorant crowd, where the surgeon is confronted from the first moment with the task of introducing order and establishing the routine, not of the medical department only but of the culinary, disciplinary, sanitary and other departments, and of maintain- ing this routine and general good order by daily personal supervision: if this suppo- sition could be reduced to the test of practical experience, we believe that there is no member of the medical staff of British Guiana who would not admit that the prob- lem was enormously more difficult and who would not, were he himself in charge, demur to a request to introduce a routine with possibly dangerous drugs.

17. The Surgeons Superintendent are confronted with all the difficulties above supposed, and are further handicapped by the prevalence, during the first fortnight, of sea sickness and its effects and by the frequent occurrence of cold, wet or stormy weather, which not only impedes routine at the moment but reduces the number of days available for getting the necessary work done. They have also, and without clerical assistance, to keep the somewhat voluminous records required by the Govern- ment of India. Very frequently too, they have to deal with serious epidemic disease. 18. Authorities on the subject lay down that thymol and beta-naphthol may act as dangerous poisons in the event of a solvent (such as oils, ethers, and alcohols) being taken during the course, and state that they should not be administered unless under proper precautions.

19. Dr. Law states that no ill effects have resulted in British Guiana from the course of treatment which he suggests; but conditions there are, as we have pointed out, comparatively very favourable. It would be quite another problem to carry out the treatment amongst 800 coolies crowded in one ship, where it would be im- practicable to effectually safeguard against accidents. Moreover the risk of accident amongst 800 would be from eighty to twenty times as great as it would be in batches of from 10 to 40, even if all other circumstances were similar.

20. Other points considered by the surgeons, all making for the same conclu- sion, might be included here, but we trust that what we have stated will be enough to convince His Excellency that the surgeons gave to this question full and serious consideration and that their duty compelled them to report on it as they did.

21. They believe that they can do more for the Colony and the immigrants by endeavouring, as heretofore, to land these latter in a good condition, which will fit them for undergoing the needed treatment on the estates, rather than by endeavour- ing to carry out a course of compulsory treatment of which they do not approve.

I have, &c.,

W. K. MILEY,

Honorary Secretary.

To the Crown Agents for the Colonies.

SUMMARY AND INDEX.

Surgeons not wanting in interest in the people or in con- sideration for wishes of Colony, and hope the Governor will reconsider the matter

Surgeons' own interest to meet view of Colony

Paragraphs 3 and 4 Paragraphs 5 and 6

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