CO885-(23-24) — Page 474

PUBLIC RECORD OFFICE

Reference :-

C.O. 885

23 PUBLIC RECORD OFFICE, LONDON

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

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Rules under Section 12 of "The Diseases (Labourers) Ordinance, No. 10 of 1912," applicable to the whole Colony, made by the Principal Civil Medical Officer, with the approval of the

Officer Administering the Government in Executive Council.

1. Permanent linea shall be as far removed as possible from jungle and swamps. They shall be built on high ground on a dry site with efficient drainage; they shall not be situated They shall not be situated in such close proximity near villages or insanitary surroundings.

to existing lines as to obstruct light and the free circulation of air.

2. Latrine buildings shall be of impermeable material throughout and properly drained. The contents of the buckets shall be regularly disposed of either by burning or burial in shallow trenches. Latrines shall be so situated as not to be likely to contaminate water supplies or to be a nuisance to the occupants of buildings.

8. A sufficient number of sweepers shall be provided on each estate to keep the lines and their surroundings clean, to bury or burn all excreta or refuse, and to keep the drains swept at least once a day.

4. In malarious districts travellers' palms, pineapples, plantains, or cultivation liable to Pigs, goats, and favour the breeding of mosquitoes shall not be allowed near the lines. cattle shall not be kept in any portion of the line buildings.

Such drains shall 5. All lines shall be provided with drains to carry off the rain water.

They shall have be constructed of stone, of brick rendered in cement, or of cement concrete. sufficient slope to carry the water well away from the lines, so that no swamps or stagnant The immediate vicinity of the lines shall be on a lower level than the floor pools are left. of the buildings and shall slope downwards from them, and all swamps or pools in the vicinity of lines shall be drained or filled in.

6. On all estates proper bathing places shall be provided for the use of labourers at spouts, pumps, wells, or riversides where possible, to consist of a stone or cement platform, with a properly constructed run-off drain.

7. It shall be the duty of the superintendent of every estate to provide a sufficient supply If wells of potable water for his labour force; such supply shall be free from contamination. are provided, they shall be covered, and be faced or pointed in cement for 10 feet from the All water pipes shall be made of iron. Burface of the ground, to prevent contamination.

platform of stone, brick cement Wells must have parapet walls, and be surrounded by rendered, or cement concrete, 4 feet wide, and peripheral drain to carry off waste water.

(No. 14.) SIR,

No. 10.

LEEWARD ISLANDS.

THE GOVERNOR to THE SECRETARY OF STATE.

(Received 3rd February, 1914.)

[Answered by Nos. 13 and 35.]

Government House, 8th January, 1914. I HAVE the honour to acknowledge the receipt of your despatch, Miscellaneous, of the 26th August,* relative to the visit to the West Indies of Mr. Wickliffe Rose, Director of the International Health Commission of the Rockefeller Foundation.

2. Mr. Rose visited Antigua from the 7th to the 8th November, and was given every facility for the investigation of his subject, and for co-operation with the medical and other authorities.

3. I enclose copies of the following papers which were handed to Mr. Rose:

Minute by Medical Superintendent of Charitable Institutions, 23rd

October, 1913.

Minute from Chief Government Medical Officer, 6th November. Letter from Commissioner of Montserrat, 29th September.

4. The following papers, of which I also attach copies, reached Antigua after Mr. Rose had left:

Letter from Commissioner of the Virgin Islands, 3rd November. Despatch from Administrator of St. Kitts-Nevis, 11th November. Despatch from Acting Administrator of Dominica, 17th November.

5. It will be seen that, according to the reports of the various Medical Officers, there is some divergence of opinion as to the degree of prevalence of ankylostomiasis in this Colony. Dr. Clarke, of Tortola, states that he has not seen a single case of the disease in the Virgin Islands. The Senior Medical Officer of Montserrat says that, during an experience of a year, he has seen no case of ankylostomiasis. The Senior Medical Officer of St. Kitts states that only stray cases are found in that island now and then. The reports from the four Medical Officers in the country districts of Dominica show that very few cases of the disease have been noticed by them. Dr. Nicholls, the Senior Medical Officer of the island, declares that the disease is found in all parts of the island, but that the people only suffer from a mild form of the infection.

No. 3 in Miscellaneous No. 297,

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6. The Chief Government Medical Officer of Antigua and most of the district Medical Officers are of opinion that, though the disease may exist to some extent Dr. among the labouring classes, advanced stages of infection are not common. Cooke states that he has seen very few cases during the past two or three years; Dr. Gabriel, after thirty years' experience, says he has only treated one typical case of hook-worm."

7. Dr. W. M. McDonald, however, in the interesting report which is attached, insists that ankylostomiasis is very prevalent in Antigua, and that, it is the cause of

great suffering and ill-health among the labouring classes of all ages."

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8. Dr. McDonald, before taking up the post of Medical Superintendent of the Charitable Institutions in Antigua, was a District Medical Officer in St. Kitts, where he distinguished himself by his keenness in matters of sanitation. He does not agree with the opinions of his confrères in St. Kitts as regards the comparative unimpor- tance and moderate distribution of the disease, and states, on the contrary, that ankylostomiasis is so wide-spread among the labouring classes in that island that, after a personal examination of the stools of 100 children, he found 65 per cent of them harboured the hook-worm. He says that "the majority of these children, although apparently well enough to attend school, were nevertheless anæmic, stunted, and badly developed, showing how the pernicious effects of this disease insidiously strike at the efficiency of the population even from the earliest ages."

9. Dr. McDonald goes on to say, "Writing of this disease in 1899 I asserted This that the harmfulness of a moderate infection cannot be overestimated." statement was severely criticized and ridiculed by one of my senior confrères at the time. In the light of thirteen years' subsequent experience of the disease, I am most emphatically of the same opinion, and I would like to point out that a most important and pernicious feature of the disease is the manner in which it exerts its baneful influence through the medium of a moderate infection, which, while not causing sufficient illness to induce the patient to seek medical relief, yet causes much suffering to, and seriously impairs the efficiency of, its unfortunate victim. Moreover, this tendency to exist in a chronic state, which does not apparently necessitate medical aid, tends to prevent the general recognition of the disease, and is liable to induce a feeling of false security concerning its non-prevalence among the population.

'I venture therefore to assert that it is not advisable to calculate the harm done by this disease in Antigua or in the other islands by the death rate as given by the Registrar-General's report or by the number of cases which happen (more or less accidentally) to have come under the notice of the District Medical Officers.

"In view of the tendency of the disease to exist in a chronic and unrecognized form, and of the importance of this disease.

To the Government, as a cause of pauperism,

To the employers of labour, as a cause of impaired efficiency,

To the general community, as a cause of much suffering, debility, and destitution, and as a contributory cause of many deaths,

"I am of opinion that it is highly desirable that we should be favoured by a visit from the Health Commission and that we may gain the great advantage of their co-operation in an attempt to eradicate the disease from Antigua."

He

10. During Mr. Wickliffe Rose's short stay in Antigua, I had the advantage of conferring several times with him on the subject of his investigation. informed me, verbally, that he had, chiefly in company with Dr. W. McDonald, visited various districts of the island, and had formed the impression that ankylo- stomiasis is widespread among the labouring classes. I understood him to say that the International Health Commission desired to select some island in the West Indies in which the disease is specially prevalent, so that a practical and conclusive illustration might be given of the repressive measures which have been followed, with such remarkable success, in some of the Southern States of North America.

11. Mr. Rose informed me that the circumstances of Antigua appeared to him to be well suited to the purposes of his commission, and proposed that, subject to the approval of all the authorities concerned, a systematic investigation to deter- mine the facts in regard to the prevalence of ankylostomiasis should be organized and undertaken. He suggested that if the investigation showed that the infection is not a menace to the health and efficiency of the people, the matter should end there.

If the contrary should be shown, measures for the control of the infection should then be considered.