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PUBLIC RECORD OFFICE

Reference :-

C.O. 885

23 PUBLIC RECORD OFFICE, LONDON

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done in the Southern States of U.S.A. than had been done in India, said that the remedies were the same, but that efforts were concentrated on educating the children in hygiene, through the school teachers the adult population were intractable as material and the Southern doctor, as a rule, a very poor instrument of reform. He added that the work done was mainly among the lower class of white people and not among the coloured population.

Dr. Daniels gave an account of the advances made in Fiji on the estates, where the problem was chiefly that of providing a sufficient number of latrines and of making them easily accessible. The larger the proportion of latrines, the easier was the task of inducing the estate labourers to use them. He thought that it was chiefly the planters and the magistrates who required educating in matters of hygiene. As for treatment of cases in hospital the difficulty was that in some districts 99 per cent. of the population were infected, and if not actually suffering from the disease were vehicles of disease among the rest. Fiji was the first Colony to take measures against ankylostomiasis after Ceylon.

Turning to the Straits, Dr. Daniels said that the disease had been little known until the importation of coolies from India. Since then planters had come to realise the seriousness of the position, and were taking measures, each for his own employés.

The disease was also known to exist in Mauritius and Hong Kong, and, speaking generally of the tropics, Dr. Daniels estimated the degree of infected persons as varying from 60 to 90 per cent. of the total native populations.

Mr. Read suggested that Sir P. Manson might be asked for an account of the work done in Ceylon if further information as to the far Eastern Colonies was

desired.

Turning to the West Indies, Dr. Clare spoke from his experience of Jamaica and Trinidad. In the former Colony the disease had not attracted much attention during his service there. In the latter Colony, where it had been found to be very prevalent, nothing much had been effected until the beginning of the present year, when legislation had been introduced requiring latrine accommodation on the sugar estates. The necessity of the measure was shown by the complete absence, previously, of latrines on estates, although as much as one-third of the total population of the Colony was of East Indian origin.

He agreed that the most hopeful methods were in the direction of educating the children in hygiene, but observed that the poor standard of education-especially in knowledge of hygiene-existing among the teachers in the Colony was a serious obstacle to progress. Generally speaking, he was in favour of recommendations Nos. (1), (2), and (3), set out in the memorandum before the Committee, and he especially emphasised the importance of the latrine accommodation being sufficient. He enter- tained doubts as to the desirability of recommendation (4), distribution of anthel- mintics.

In conclusion, Dr. Clare alluded to the difficulty experienced in Trinidad of obtaining reliable statistics of the disease, owing to the indeterminate and incon- sistent nomenclature too often employed by medical officers in making their returns. He added, however, that the disease was undoubtedly widespread in the Colony.

With regard to British Guiana, where hook-worm disease existed to a serious extent, Mr. Grindle said that Dr. Godfrey, the Surgeon-General, was on leave in this country, and could furnish first-hand information on the subject. It was under- stood that Dr. Godfrey had achieved remarkable success in convincing estate owners of the desirability-in their own interests of providing latrines for their employés. It was decided to invite Dr. Godfrey to attend the next meeting of the Committee.

Mr. Grindle then referred to the recent conference of the surgeons of the vessels chartered by the Indian Emigration Agencies to consider the question of treating coolies on ship board, and he read to the Committee the resolution passed at the Conference, the substance of which was that treatment

en masse " of coolies on ship-board was impracticable.

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Sir Havelock Charles suggested the alternative of treatment at the Emigration Depôts prior to embarkation. The difficulty, however, which this method presented was the risk that the coolies, resenting the restrictions thereby placed upon them, would desert.

The problem of treatment, Mr. Grindle observed, presented especial difficulties when it was a question of treating-not coolies, over whom some measure of control could be exercised, but the ordinary native population; in particular, where they were largely savages, as was the case in tropical Africa.

Sir H. Charles pointed out, in this connexion, the possible danger of

attempts to promote under impossible circumstances methods only appropriate to This was with special conditions such as prevailed in the United States of America. reference to India.

Mr. Read said that the object of the formation of the Committee was in part to consider how to avoid this contingency.

A few special points were then touched upon.

Sir H. Charles thought that a cheap form of incinerator, which could be con- structed locally, would be useful for the disposal of fecal matter, and the fæcal matter would itself be of some use in cases where fuel was largely used, e.g., on tea estates.

Sir T. B. Robinson said that in Australia the smaller townships could not afford to use fuel for the single purpose of destroying fæcal matter.

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Dr. Daniels mentioned the use of "acid water for laying the dust in mines, as employed in the Transvaal, as one of the few advances in method which had taken place during recent years. The acid in the water served to prevent the breeding of the ankylostome in circumstances which, by reason of the dampness and warmth, would otherwise be very favourable.

Generally speaking the Committee agreed in approving recommendation (1) of the memorandum, with the modification that a definite percentage of latrines should be required; and in strongly discouraging recommendation (4)

The question of a further preliminary meeting before the meeting with Mr. Rose was then discussed. Mr. Grindle did not think that another such meeting was necessary. All that was needed was that when meeting Mr. Rose the Secretary of State should have at his disposal (1) sufficient information to show what had been done in various parts of the Empire, and what methods were generally approved or disapproved; (2) some indication of the most suitable fields for the American Commission to visit, whether with a view to acquiring information or to imparting it. It appeared that the various parts of the Empire dealt with at the meeting possessed full information as to the disease and as to methods of combating it; and that the problem was largely one of money, as in the West Indies, or of treating large numbers of intractable savages, as in Tropical Africa, where conditions prevailed of which the American Commission could have no special experience. If, on the other hand, the Commission desired to acquire information, Ceylon and the Malay States were suggested as the most suitable fields.

As regards the provision of further information, it was considered that the papers which were being prepared for the Committee by Dr. Mayer and Dr. Bag- shawe should be printed for distribution.

A Committee was formed in 1908 to deal with the question of ankylostomiasis.

They made recommendations which may be summarised briefly as follows:-

(1) Legislation to enforce the provision on estates of latrines of suitable construction and situation, and imposing penalties on persons avoidably defecating under conditions likely to cause risk of infection;

(2) Division of each Colony into districts, each under the supervision of a Sanitary

Officer responsible to local authority;

(3) Educative campaign, by object lessons in schools and distribution of pamphlets;

Distribution from convenient centres, e.g., post offices and schools, of anthelmintice

at cost prices;

and these recommendations were communicated to the Colonies concerned.

On July 17th, 1913, Mr. Walter Page, the American Ambassador, through Sir Edward Grey, approached the Secretary of State with a view to a conference about measures against ankylostomiasis in British Colonies between him and the Director of the Rockefeller Inter- national Health Commission.

The outline plan of work of the Commission is that Mr. Rose, the Director of the Inter- national Health Commission, and his assistants should go to India and the Colonies to show what has been done in the Southern States of the United States of America and set similar work going elsewhere.

The present meeting has been called in order to prepare an outline of a programme for discussion with Mr. Rose.

It is thought advisable in order to define the discussion of this subject to form a preliminary Committee to consider-

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(1) The problem;

(2) The way it has been met up to the present;

(3) The best method of forwarding the aims and objects of the International Health

Commission in

(4) The Colonies most seriously crippled by the disease or in which economic progress is

seriously hampered.

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