CO885-(23-24) — Page 471

PUBLIC RECORD OFFICE

Reference :-

mmimmimi.C.O. 885

23 PUBLIC RECORD OFFICE, LONDON

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

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Treatment.

For the purposes of treatment coolies are to be separated into two groups: (a) the new arrivals; (b) the residents of longer standing.

(a) As to the New Arrivals.-It has been ascertained that practically all Tamil coolies harbour bookworms; on arrival in Ceylon, therefore, superintendents or estate dispensers should give every newly-arrived adult coolie 15 grains of beta- naphthol (3 tabloids) at 6 a.m. on an empty stomach, and a second dose of 15 grains

Half an ounce of Epsom salts. the same day one hour before the evening meal.

Children dissolved in a little water should be given on the following morning. from 5 years to 13 years of age should be given 5 grains of beta-naphthol (one tabloid) at 6 a.m., and another 5 grains of beta-naphthol one hour before the evening meal, and a teaspoonful of Epsom salts the following morning.

Note. It is most important that neither arrack nor oil of any kind should be taken, either before or after the doses of beta-naphthol.

(b) As to Residents of longer standing.—The signs of anchylostomiasis are feebleness of body, swelling of ankles, puffiness of face, and very pale gums, tongue, and inside of eyelids (anæmia). If not sufficiently ill to be sent to hospital, adult coolies should be treated on the estate with a dose of 30 grains (six tabloids) of beta-naphthol at 6 a.m. on an empty stomach, and half an ounce of Epsom salts the following morning. A second dose of 30 grains of beta-naphthol at 6 a.m. on the seventh day after the first dose, to be followed by half an ounce of Epsom salts on the next morning. After the second dose of beta-naphthol and salts one tabloid of carbonate of iron (5 grains) should be given twice a day after meals for a fortnight.

If the symptoms are not greatly improved after the completion of one period of treatment, a second period of treatment should be carried out, on exactly the same lines as the first.

Children between 5 and 13 years of age are to be given 5 grains of beta- naphthol where 30 grains are recommended, and half a tabloid (2) grains) of car- bonate of iron where 5 grains are recommended above.

In carrying out this treatment, as in the case of new coolies, arrack and oil should be entirely prohibited.

Prevention.

The prevention of hookworm may be summed up in the word "Sanitation."

Rules.

1. Every set of lines and its immediate surroundings should be swept clean once a day at least. All sweepings should be burnt; failing this, buried.

2. Any deposit of excreta should be carefully removed and buried a foot

deep in as dry a soil as possible, and at an unfrequented spot.

3. At least 12 feet clear of all vegetation must be maintained round the lines. 4. The floor level of the lines to be higher than the surrounding ground; the latter to slope away from the lines so as to allow water and slops to run away by gravity.

5. Drains made of stone, brick rendered in cement, or cement concrete should be constructed to carry off the rain from the roof and from the immediate vicinity of lines.

6. Verandahs of lines are not to be enclosed or occupied by coolies and goats. 7. At all bathing places, whether at spouts, wells, or riverside, there should be stone or paved platforms for coolies to stand on, with a properly constructed run-off drain where necessary.

8. Wells for bathing and wells for drinking are to be kept separate.

9. Protect the water supply by conducting it in iron pipes (not coffee spouting) to standpipes or taps. If wells are in use they must be covered and supplied with pumps, the well lined with brick pointed with cement, with parapet walls, and a surrounding platform of stone, cement concrete, or brick cement rendered 4 feet wide, with a surrounding drain to conduct the waste water away.

10. The most important preventive measure is the proper disposal of the solid excreta, and the only efficient way of carrying this out is by collecting it in buckets (in cheaply constructed latrines), its regular removal by a conservancy gang, and burial in trenches a foot deep by a foot wide, which are planted subse- quently with guinea or water grass; the same piece of ground to be used over and over again.

The attention of agents, visiting agents, and superintendents of estates is invited to the above rules, and it is hoped they will do all in their power to see them carried into effect.

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General.

The drugs required for the treatment of hookworm will be issued from the Sinhalese and Civil Medical Stores to superintendents of estates at cost price. Tamil labourers on estates may be treated free for hookworm on any estate which draws the capitation grant for free drugs, provided that the grant is not exceeded. Superintendents are warned that on estates where hookworm is prevalent in a severe form the recommendations made by any Inspecting Medical Officer sent to report on the sanitation of those estates by the Principal Civil Medical Officer, and which recommendations are approved by the Principal Civil Medical Officer, must be carried out. Should a superintendent fail to comply with these recom- mendations within three months, they will be carried out by Government, and power will be taken to recover the cost thereof from the estate.

A. PERRY,

31st October, 1910.

SIR,

Principal Civil Medical Officer.

Enclosure 2 in No. 9.

REPORT OF THE ANCHYLOSTOMIASIS COMMITTEE.

In reply to your letter of 26th May last, appointing us a Committee to con- sider and advise as to the measures to be taken to prevent the spread of anchylosto- miasis in the Island, we have the honour to submit the following report:-

2. The Committee met in Kandy and in Colombo, and examined witnesses, both medical and planting. We also received replies to a series of questions which we addressed to gentlemen who were likely to be able to give useful information to the Committee on the subject. The evidence and the written answers to the ques- tions which were asked are attached as appendices to this report.

3. The conclusions at which we have arrived on the evidence that has been brought before us are summarized in the following recommendations:-

(1) That all superintendents of estates should treat new arrivals with beta-naphthol, followed by tonics; particulars of the course of treatment recom- mended by the Principal Civil Medical Officer, according to the age of the labourer, are annexed. The ground for this recommendation is that the per- centage of coolies arriving in the Island who are suffering from this disease in a more or less marked degree is so high that the disease may be said to be practically universal. In the rare cases where it does not occur the treatment will not be injurious.

(2) Where it is known that anchylostomiasis already prevails on estates, superintendents should treat the whole labour force in convenient batches in a similar manner. We have ascertained that coolies do not object to the treat- ment, which can be carried out without greatly interfering with the labour force.

(3) When any case of anchylostomiasis occurs amongst labourers admitted This is for the to hospital, the medical officer should notify the employer. purpose of informing superintendents who may previously have been in ignorance of the existence of the disease on their estates, in order to enable them to take action forthwith.

(4) The drugs required for the treatment should be issued at cost price from the Civil Medical Stores. Where estates have dispensaries and are there- fore allowed a small sum per coolie for medicines, we recommend that the drugs required for the beta-naphthol treatment may be used for Sinhalese as well as Tamil labourers up to the limit of the present capitation grant for free drugs for Tamil coolies. Under existing conditions employers have to certify that medicines have been used for their Tamil coolies only, and any drugs required for Sinhalese labourers have to be paid for, even though the limit allowed for free medicines has not been reached. It is highly desirable that facilities for treating Sinhalese should be granted, as otherwise they may be the means of introducing the disease into their villages, where it has hitherto been almost unknown.

(5) Medical officers in charge of districts should report to the Principal Civil Medical Officer, through their immediate superiors, the prevalence of anchylostomiasis in a severe form on any estate. In such cases the Principal Civil Medical Officer should be empowered to send an officer of his Department to inspect. report, and make recommendations for combating the disease. If

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