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PUBLIC RECORD OFFICE

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C.O. 885

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12. I attach a copy of a letter, dated 28th November,* which I subsequently received from Mr. Wickliffe Rose, in which he puts those proposals on record, and offers to take steps to provide the funds required for the investigation.

13. I also attach a copy of a further communication dated 26th December, from Mr. Wickliffe Rose, covering the outlines of a scheme for the organization of a similar project for Grenada, and indicating the nature and strength of the staff which would be required.

14. It appears to me that the staff proposed for Grenada would be adequate and suitable for the work which it is proposed to do in Antigua. I have written to Mr. W. Rose in that sense, and have informed him that, subject to your approval, this Government is prepared to gratefully accept the assistance proferred by the International Health Commission of the Rockefeller Foundation."

15. I shall be glad to receive, by cable, an intimation of your concurrence in this project, so that may be in a position to settle details with Mr. Wickliffe Rose before he starts on his projected tour to Egypt and the Malay States.

I have, &c.,

Enclosure 1 in No. 10.

H. HESKETH BELL,

MINUTE BY Superintendent of Charitable InsTITUTIONS.

HONOURABLE COLONIAL SECRETARY,

Governor.

It may be quite true that there is not great loss of life directly due to ankylo- stomiasis in Antigua, but there is no doubt that it is a very important contributory cause to the number of deaths attributed to other diseases. It is probable also that many deaths which in the Registrar-General's report come under the heads of debility and anæmia are in reality due to ankylostomiasis.

I have no doubt that there is great suffering and ill-health among the labour- ing classes of all ages, of which the unrecognized cause is ankylostomiasis, and that there is also a corresponding decrease in general efficiency of the labouring population.

my district In this connexion I should like to mention a case I came across in work in St. Kitts. This was a young man of 22 years, who came to me, not for medical relief, but for poor relief, as he had been quite unable to work for many months. I diagnosed ankylostomiasis and confirmed this by a microscopical exam- ination of his stools: he was suffering from a very severe attack of the disease. I treated him at his own home with thymol, and in a very short time he was restored to robust health, and was able to resume his work as an estate labourer, and to sup- port himself. I mention this case for two reasons: first, because I showed him to the members of my District Board with a view to impressing on them the economic effect of this disease on the labour supply, and the advantage to be gained by adopt- ing suitable preventive measures on the estates and in the villages; second, because this is a striking example of a case which, left along and undiagnosed, would have become a pauper and a burden to the Government, perhaps for many years. There are doubtless many similar cases throughout the Colony dependent on Government relief.

In regard to the age incidence of this disease, I might mention that in my district in St. Kitts, I personally examined in my dispensary the stools of 100 children from 2 schools, and found that 65 per cent. of the children harboured this worm. I also particularly noticed 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.

I attach a copy of my official report on the examination of these children. I notice that in the report received from the Leeward Islands in 1909, it is stated that the disease is not prevalent except perhaps in Antigua, and no special In this connexion I beg to measures were considered necessary to cope with it. state that in my district in St. Kitts this disease was decidedly prevalent both before and after 1909, and though the mortality from it was relatively small, yet the disease was exerting a pernicious effect on the health and general efficiency of a large number of children and labourers in the district (see my report attached to St. Kitts-Nevis Medical Report, 1908), and though I had not the advantage of

*Enclosure 8 in No. 12 in Miscellaneous No. 297.

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seeing the Secretary of State's despatch in 1909, yet I took measures in my district for combating the disease, which measures did not involve any great expenditure, the fear of which is the reason given for inaction in other places.

I have not had a similar opportunity of judging of the prevalence of this disease among the labourers and children of Antigua; I can therefore only speak of its prevalence in the patients in the hospital.

Recently the stools of 191 patients in the hospital were microscopically I attach the list* examined, and 23 cases were found to be infected with the worm. giving names and residences: from this it is seen that the disease is prevalent throughout the island. This represents only a very small percentage of the number of cases in the island. The disease can only be diagnosed by a careful microscopical examination of the stools: this is never done outside of the hospital, and therefore the cases come into the hospital for debility, anæmia, and destitu-

tion.

I have lately had 3 severe cases from the Industrial School: it is most likely that the boys are badly infected, and I think that all the boys should be specially examined and treated for this disease. I am prepared to do this, and Dr. Duke has given me permission to begin at once if His Excellency approves.

Writing of this disease in 1899, I asserted that "the harmfulness of a moder- ate infection cannot be overestimated." This statement was severely criticized In the light of thirteen and ridiculed by one of my senior confrères at the time. 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 seri- Moreover, this tendency ously impairs the efficiency of, its unfortunate victim.

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.

I note in the Secretary of State's despatch that information is also sought as to the measures taken to combat the disease. In this connexion I may mention that in my district in St. Kitts I personally treated a great many cases with thymol, and initiated a sanitary campaign having in view the destruction of the breeding places of flies and mosquitoes, the prevention of ankylostomiasis, and general improvement of the sanitation of the villages. In this manner a great improvement was effected through the agency of Sanitary Inspectors, whose duty it was to see to the proper disposal of excreta, which is the most important measure in the prevention of ankylostomiasis. I also instructed the school teachers in the nature of the disease and in the methods to be taken for its prevention.

I think that measures might with advantage be taken in Antigua on the same lines as those I initiated in St. Kitts, but that, in view of the pending visit of the Health Commission, it would be as well to wait and see if the Commission will visit Antigua, in which case we shall have the advantage of their experience to guide us in an attempt to eradicate the disease.

W. M. McDonald.

23rd October, 1913.

*Not received in Colonial Office.

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