CO885-(23-24) — Page 104

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PUBLIC RECORD OFFICE

Reference :~~

C.O. 885

23 PUBLIC RECORD OFFICE, LONDON

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

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Thus, out of 818 centres (including those of under 10 persons) no less than 679 have a population of only 500 or less. As there are 408 persons to each house on the average, it follows that a village with 500 persons possesses only less than 125 houses. I anticipate that at first the total fund of £2,500 a year asked for will be expended mostly for work in the larger villages, exclusive of the municipalities, that is, in about 130 villages. Distributing £2,000 of the fund amongst these, each would obtain about £15 a year. Later on, when the larger villages have been dealt with, the smaller ones can be attacked. Generally, the Sanitary Department will have to decide where the money can be most profitably spent to begin with; and the general rule will be followed, that anti- mosquito work is most advantageous where the population is thickest, because then the same expenditure benefits the largest number of people. On the whole, therefore, I think that a great deal can be done with the suggested expenditure, and that it will be a very great boon to the rural population of Cyprus. It is beyond my province to examine how the money can best be ob- tained; but I feel that the need is a most urgent one.

We considered carefully the question as to whether labour for such works should be obtained in each village only when actually required, or whether it would not be better to appoint a permanent sanitary labourer for each group of villages-the total cost being supposed to be the same in both cases. On the whole, we decided that the former course would be the better one, but only ou condition that the payment for sanitary labour should be rather in excess of that for ordinary unskilled labour, in order, if possible, to attract the same labourer for the work when required every year. This would save the maintenance of the permanent labourers at times during the middle of winter, when little work will be required of them; while it will also ensure that men accustomed to the work will always be at hand. Generally, these men will be residing in the villages where their services are needed, and it will be a part of the Sanitary Engineer's duties to select the men and to have them always available, if possible, when they are needed. Thus, we thought, the total grant under this heading will be most economically used for the actual benefit of the people.

I cannot insist too strongly upon the necessity for some such fund. Medical Officers, Sanitary Inspectors, and Sanitary Engineers are themselves powerless unless the actual manual labour required by them can be obtained.. The absence of funds for such sanitary labour has heen indeed the great sanitary defect of many British Colonies and other countries.

All the fund should, I think, be expended directly under the Chief Medical and Sanitary Officer-that is, under the Government itself. The villagers themselves cannot possibly know how to spend their money properly. If they are allowed to interfere in the expenditure they will only waste the grant. On the other hand, they should be allowed, if they contribute to the fund, to make as many representations as they please regarding their sanitary needs. In every way it will be better for Government to give the money to begin with. This will enable it to keep

an absolute control over the expenditure, at least until the scheme has been in working for some years.

(6) The additional sum of £500 advised for the distribution of quinine may be allotted as follows:-Perhaps we should set aside £100 a year for the putting up and distribution, and £400 for the quinine itself. At current wholesale prices this will provide 768,878 doses of five grains of sulphate each. Supposing that only 50 doses were allotted for the treatment of each case (and perhaps 100 doses would be nearer the mark), this would suffice for treating only 15,377 cases. Taken together with anti- mosquito measures, this amount of quinine would, I am sure, be very useful; but if the anti-mosquito measures are omitted, the amount of quinine must be immensely increased if any large effect on the malaria is contemplated. In fact, I doubt whether un exclusive and complete quinine prophylaxis in Cyprus would not cost much more in the end than the partial quinine prophy- laxis combined with the mosquito-reduction policy suggested in this Report. It would certainly be much more troublesome to the people in the end.

As discussed in my report on "The Prevention of Malaria in Mauritius," quinine distribution will be of no use unless the drug is given away broadcast, without let or hindrance, to all those who demand it. The Chief Medical Officer is already fully cognisant regarding the best methods of distribution in Cyprus, and I therefore have nothing to say but that his advice should be taken. I think that tannate of quinine is probably the best salt for public health distribution, but it is more expensive. It is useful also to put up the drug in packets containing 100 grains of sulphate in 20 tablets of 5 grains each, on my method of "Treatments," as laid down in my quinine distribution by Mauritius Report.

(7) Much public health analytical work will be required in Cyprus, besides experiments upon the destruction of larvæ by fish and by culicicides. But more than this, all biting flies afflicting men and animals should be carefully collected, identified We in England, and studied in Cyprus as regards their habita. think that the Government Analyst could do the work if he receives an additional grant not exceeding £50 a year for it, including the cost of the experiments,

(8) This item was strongly recommended to me when I was in Cyprus. It is felt that the pay of the. Medical Department is very low, and also that very few of the officers have obtained the modern diplomas in tropical medicine. By the arrangement suggested the pay will be improved if the said officers obtain the necessary diplomas. The difficulty has been that many of the Greek medical men do not understand English sufficiently to be trained in England. It therefore occurred to me that they may possibly receive adequate training in Greece; and it was partly for this reason that I went to Greece after my visit to Cyprus. No certificate in tropical medicine is given by the University of Athens, for the simple reason that most of the medical science taught in Greece may be taken as coming under

• About 11d. per onnoe of 437-5 greina,