CO885-(23-24) — Page 476

PUBLIC RECORD OFFICE

Reference :-

ITT CO. 885

23 PUBLIC RECORD OFFICE, LONDON

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

26

Enclosure 2 in No. 10.

MINUTE BY CHIEF GOVERNMENT MEDICAL OFFICER.

HONOURABLE COLONIAL SECRETARY,

I REGRET that my minute of 29th September, 1913, was inadequate, and, obeying His Excellency's order, I have consulted with the other District Medical Officers, and, in the light of later and fuller information obtained, now beg to The difficulty in prepar- submit the following minute in lieu of my previous one. ing an adequate report on ankylostomiasis in Antigua arises from the lack of special work having been done in this connexion.

To guess and surmise is no good in scientific work. and experiments must be obtained.

Facts, accurate records,

Ankylostomiasis has been known to exist in Antigua for many years, but the exact percentage of the population infected by the worm is unknown, but is believed to be large. In the last Annual Report of the Registrar-General the deaths ascribed to this disease are 7 out of a population of over 30,000. There are no data or statistics from which one can say in the words of the Secretary of State whether or not there exist here "great suffering, loss of life, and the decrease of economic efficiency directly due to ankylostomiasis." It is unjustifiable to say that great suffering, ill-health, decrease in general efficiency, anæmia, stunted development, etc., are directly due to ankylostomiasis because one finds an egg of the worm in a patient who happens to have some of the above-mentioned aflic- tions, especially as such patient is most probably living under the most deplorable sanitary conditions, with an insufficiency of proper nourishment, and possibly suffering at the same time from some other disease, such as acquired or hereditary syphilis, malaria, kidney disease, etc., which, in themselves, if neglected, are capable of producing all the above symptoms. Every medical man knows that when the above conditions are found in conjunction with the hook-worm, the combination is a most disastrous one, but we have not on this island anyone sufficiently skilled to say how much is to be attributed to one and how much to the other.

I think it possible to be a carrier of the worm and yet to suffer no inconveni- This, I believe, the best ence from its presence, or to display any symptoms.

I should like to quote two authorities teach, especially as regards the black race. recognized writers on this point. Sir Patrick Manson says, "It is not in every instance in which the ankylostomum is present that consequences so serious ensue. There may be dozens of ankylostomes in the intestine without any appreciable anæmia, or, indeed, symptoms of any description whatever. Grave symptoms are the exception. One must be careful, therefore, to avoid concluding that the ankylostomum is the cause of every pathological condition with which it may Dr. G. E. Brooke writes, "A moderate infection may cause no chance to concur." symptoms at all. Probably several hundred are necessary to cause damage to the general health.”

Though 90 per cent. of the population may be found to be infected with the worm, the experience of other District Medical Officers and myself in Antigua is, that the advanced stages of cachexia, suffering, and inefficiency caused by its presence are quite exceptional. Nevertheless, it behoves us to rid the island of the pest if possible.

Let me cite the weighty words of doctors of many years of residence in "In my experience the cachexia produced by the Antigua. Dr. Branch says: presence of the hook-worm is rarely seen in Districts 4 and 1, but slight infections Dr. Cooke states: "I have seen a few cases of ankylostomiasis are very common.'

I have seen no reason to believe that it is so during the past two or three years. widely distributed as to figure largely as a cause of sickness or invaliding among the labouring population. The anæmias due to malarial and other cachexias are Dr. Gabriel writes: "I have not had more than one much more in evidence." typical (clinically) case (of hook-worm) to treat, and that, too, occurred in a patient who had been resident for years outside Antigua." The last writer has, With regard to I think, spent thirty years in the island, and saw one bad case. the measures taken here to cope with the disease, I beg to state that literature bearing on the subject has been put into circulation, the Government Medical Officers give directions for personal and domestic cleanliness, and, if I am informed aright, an altered code in the elementary schools is in course of preparation, which will embrace such subjects as sanitation and hygiene.

M. P. DUKE,

6th November, 1913.

Chief Government Medical Officer.

SIR,

(No. 687/655.)

Enclosure 3 in No. 10.

Commissioner's Office, Montserrat, 29th September, 1913. WITH reference to your letter No. 299/3275 of the 23rd instant, and to the Secretary of State's despatch contained therein, I have the honour to enclose a minute of the Senior Medical Officer on the subject.

2. The Junior Medical Officer, who is in charge of District 2, also says he believes that ankylostomiasis is practically non-existent in Montserrat.

I have, &c..

The Honourable

The Colonial Secretary,

Antigua.

LESLIE JARVIS,

Acting Commissioner.

MINUTE OF THE SENIOR MEDICAL OFFICER.

HIS HONOUR THE ACTING COMMISSIONER,

NOTED.--I am glad to say that, during an experience of a year, I have not seen a case of ankylostomiasis in Montserrat.

The sloping and dry surface of the soil would be unfavourable to the life of the ova of the parasite.

27th September, 1913.

Enclosure 4 in No. 10.

(Virgin Islands. No. 168/471.)

SIR,

J. C. MCPHERSON.

Commissioner's Office, Tortola, 3rd November, 1913.

I HAVE the honour to acknowledge the receipt of your despatch No. 175/3275, of 24th September last, enclosing copy of Secretary of State's despatch Miscellaneous, asking for particulars of the prevalence and distribution of ankylostomiasis and of the measures taken to cope with it.

2. It gives me pleasure to report that I have not seen ankylostomiasis during the tenure of my appointment here.

I have, &c.,

The Honourable

SIR,

The Colonial Secretary,

Leeward Islands, Antigua.

a single case of

T. L. CLARKE, M.D., C.M.,

Acting Commissioner.

Enclosure 5 in No. 10.

(St. Christopher, Nevis. No. 325.)

Government House, St. Kitts, West Indies, 11th November, 1913. I HAVE the honour to acknowledge the receipt of Your Excellency's despatch,

No. 334, of the 29th October, calling attention to Your Excellency's despatch, No. 298, of the 20th September, on the subject of the prevalence, etc., of ankylosto- miasis in this Presidency, and to express my regret for the delay which has occurred in supplying the information desired.

2. I now transmit a copy of a minute by the Senior Medical Officer, to whom Your Excellency's despatch of 20th September was referred, from which Your Excellency will be glad to learn that the disease is not prevalent in this Presidency. 3. I may add that increased latrine accommodation is being gradually pro- vided in the town of Bassterre, and that the villages of Dieppe Bay, Old Road, and Sandy Point have recently been provided with public latrines.

I have, &c.,

T. LAURENCE ROXBURGH,

Administrator.

His Excellency

Sir Henry Hesketh Bell, K.C.M.G.,

Governor of the Leeward Islands.