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PUBLIC RECORD OFFICE

Reference :-

mmimmin C.O. 885

22 PUBLIC RECORD OFFICE, LONDON

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

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malaria mortality among them-statistics which could be kept very accurately if insişted upon.

Headings 17 b and c give the result of special enquiries regarding the fre- quency of malaria and filariasis—enquiries which could often be carried out at the expense of very little trouble.

The remaining headings attempt to measure the efforts which are being made against the diseases under reference. Headings 8 and 12d indicate the number of medical men and their average salary. From heading 12 we should be able to esti- mate the percentage of the total expenditure of a Colony devoted (b) to total medical and sanitary efforts; (c) to the upkeep of Government hospitals and dispensaries; and (e) to sanitation alone-important figures in all sanitary work. Heading 13 gives necessary information regarding the principal towns of à Colony,

Heading 17 allows for report on many other details-legislation against mos- quito-breeding, drainage, reclamation of marshes, numbers of men employed, distri- bution of quinine, increase or decrease of the diseases, and all such other efforts as the reporting officer is able to mention or describe. Heading 17 (i) indicates the legislation adopted regarding the " housing of the poor "—that is, of course, building laws.

The Return, if properly filled in, is therefore capable of yielding a valuable record, both of the frequency of mosquito-borne diseases in each Colony, and also of the vigour and extent of the measures taken against them, and, by implication, the efficiency of the local sanitary administration. It will save misapprehension to add that there should be no difficulty in filling it in. I supposed that the reporting officer would generally be the head of the Medical and Sanitary Depart- ment, who should obviously exist under every local Administration. Such an officer must have an office in which all the information asked for under every heading of the Return ought to be filed as a matter of course, and as a part of the ordinary and fundamental duty of the office. In such an office, the filling in of the Return ought not to occupy more than one or two hours at most. Of course, in certain Protec- torates and other areas some of the information asked for is really not available; but this can always be stated and explained; and the covering letter of the Secretary of State (Annual Report, 1910, page 20), expressly permits such a course.

3. Explanation of Abstracts I. and II.-Nearly all the figures asked for in the Return are actuals and not ratios-in accordance with the statistical rule that ratios are of little value by themselves. But I have now calculated the ratios under the most important headings of the Return and append them in Abstracts I. and II., which, therefore, furnish a useful review of all the Returns for the 21 Colonies which have submitted them for the year 1910. The Returns for 19 of the Colonies were published in the Annual Report of the Advisory Committee for 1911, pages 4-70: but those for Jamaica and Sierra Leone have been sent to me subsequently, and I have also received additional details regarding Uganda--all of which are embodied in the Abstracts. Returns for the Gold Coast, Northern Nigeria, and some West Indian Colonies have not yet been received by me.

I have confined myself to the Returns for 1910 actually received, because the preparation of a memorandum based on facts obtained from other sources, such as the numerous medical and sanitary reports of the Colonies, would be an extremely large undertaking, and one which is, I believe, outside my reference.

The Abstracts deal only with malaria, because the figures for yellow fever. dengue and even filariasis are too scanty to be tabulated with advantage. But they will be referred to in the following section of this memorandum.

The Colonies are arranged in geographical order from west to east, and north

to south.

Abstract I. gives the densities of population, the birth-rates, the total death- rates, the seasonal death-rates (total, and in towns), and the percentage of admis- sions and attendances for malaria, together with most of the actuals on which they are based.

The densities of population, the birth-rates and total death-rates are obtained in the usual way. The seasonal death-rates are found by adding the deaths during the four months which have consecutively the highest death-rates, subtracting half the sum of the deaths during the remaining months, and finding the percentage to the total population-by my method based on Meldrum's law. In the case of

Appulation-

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Jamaica, St. Kitts Nevis, and Barbados, however, the three most unhealthy months are taken, as the monthly figures are not given.

The percentage of admissions and attendances for malaria are obtained in the usual way, and give a good review of the great frequency of the disease in the affected Colonies.

Abstract II. gives the percentages of the whole medical and sanitary expendi- ture and the sanitary expenditure (where given) to total expenditure; the medical service; the cost of "major works " against malaria; the number of men employed

"minor works and the amount of quinine distributed.

on

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The Abstracts are summarised in Section 6 of this memorandum.

4. The Returns for 1910 in Detail.-(1) Bahamas.--Return under date 31st January, 1911, signed by Acting Medical Inspector and by Resident Surgeon. Sparse population. Doubtful vital statistics. High birth-rate. Low death-rate. No yellow fever, dengue, filariasis and blackwater fever. A small amount of malaria, The main varieties of Culicidae mostly of a benign type" (species not stated). are present." Quinine sold at cost price. A mosquito-proof quarantine (?) hospital. Anti-mosquito regulations, but no prosecutions. No anti-mosquito work, major or minor. One sanitary officer and 29 medical men. Apparently no complete sanitary organisation. No spleen census.

(2) British Honduras.-Report dated 3rd April, 1911,* unsigned. Sparse population. No yellow fever, dengue, filariasis, or blackwater fever admitted. Rather high malaria admission rate (127 per cent.). No record of attendances at the three Government dispensaries. Thirteen medical men. Appears to be a Cen- tral Board of Health and Quarantine. Anti-mosquito legislation, and 1,648 notices issued. It is stated that people were examined for enlarged spleen and for filarial diseases, that the number examined was not known, but that the results were nega- tive: which is not to be believed. Regarding major works, it is recorded that "part were "filled" whatever that may mean. Apparently no minor of Newton Barracks

every works and no distribution of quinine. We read, however, in conclusion, that " effort is being put forward in regard to anti-malarial measures, as there is improve- ment, and these measures are in keeping with the funds available.”

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In a previous report (Annual Report of the Advisory Committee for 1909), the Governor calls attention to the fact that the medical officers are often employed on other duties than their proper ones; the Colonial Surgeon says that: "In Belize, much has been done in the way of clearing brush, drainage, and the introduction of the Mosquito Ordinance," but that he cannot say that" any anti-malarial measures in the districts. But in the following of a vigorous kind have been carried out sentences he says that " steps to clear the bush have been adopted" in almost all the districts, and that "special attention has been paid to the filling in of puddles and swamps." In fact the Return is almost meaningless.

(3) Jamaica.—Return under date 7th February, 1912,* unsigned. High birth- rate and medium death-rate. No yellow fever or dengue, and only 7 admissions for filariasis and 1 for blackwater fever. High malaria admission rate (28-9 per cent.), in 20 hospitals. Apparently no out-patients. There were 107 medical men and 10 health officers. School attendances not reported intelligibly. Anti-mosquito legislation existed, but the bye-laws were " not so far accepted by Parochial Boards.” A malaria census among children is reported. The number found infected varied from 131 per cent. to 455 per cent. with a mean of 322 per cent.-a very high malaria rate; but the number of children examined is not given, showing ignorance No men of the statistical rule. Major anti-malaria works cost £2,378 and more. employed exclusively for minor works. Quinine distributed both to the public, to schools and on estates. Statistics of malaria among troops and Europeans are given, and the disease is reported to be very prevalent among new batches of coolies.

Letters on the subject are also published in the Annual Report of the Advisory Committee for 1912. That from the Superintending Medical Officer refers to the Malaria Commission (not mentioned in the Return); describes the distribution of quinine; and asks for an entomologist, and for special officers of health (though in the Return it is stated that there are 10 such officers already). Another officer refers to the screening of Port Antonio Police Station (not mentioned in the Return), and makes remarks, verified elsewhere, on the partial failure of quinine prophylaxis; and others add observations of interest.

* In Appendix I. to [Cd. 6024].

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