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PUBLIC RECORD OFFICE

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C.O. 885

24 PUBLIC RECORD OFFICE, LONDON

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No. 26.

BRITISH GUIANA.

THE GOVERNOR to THE SECRETARY OF STATE.

(Received 29th September, 1914.)

[Copy to Tropical Diseases Bureau, 12th December, 1914. L.F. See No. 52.]

[Acknowledged 15th October, 1914.]

(No. 379.) SIR,

Government House, Georgetown, Demerara, 10th September, 1914. IN continuation of my despatch, No. 157, of the 6th of May,* I have the honour to transmit a copy of a report by Dr. K. S. Wise, Surgeon-General, on the work done in the Peter's Hall District towards the eradication of hookworm disease The report is in the hands of the during the quarter ended 30th June, 1914. printer, and printed copies of it will be transmitted as soon as received.

2. I enclose also a copy of a letter which Mr. Wickliffe Rose, on behalf of the International Health Commission, has addressed to Dr. Wise, expressing the com- mission's grateful appreciation of the hearty co-operation which has been given by the Government in this work.

3. The Government Medical Officer in charge of the Peter's Hall District has well merited the commendation you have already bestowed on him for his work in improving the sanitation of, and to eradicate disease in, this thickly populated district.

I have, &c.,

Enclosure 1 in No. 26.

WALTER EGERTON.

REPORT ON THE WORK DONE IN THE PETER'S HALL DISTRICT TOWARDS THE ERADICA- TION OF HOOKWORM DISEASE.

(Quarter ending 30th June, 1914.)

1. The campaign was begun on 12th March, 1914, under the immediate super- intendence of Dr. H. H. Howard, who was specially sent for this purpose by the International Health Commission of the Rockefeller Foundation.

2. The Peter's Hall District was divided into three areas, of which B, the middle one, comprising the villages between Agricola and Providence Pasture, was selected for the beginning.

3. In this area B, as Dr. Howard's report shows, a complete census has been taken with microscopical examination; 3,545 people were counted, and 3,309 examined, showing an infection of 1,918, or 57.6 per cent. Of these 1,918 Dr. Howard records that 1,860 have started under the treatment by the "daily" method, viz., a small dose of thymol taken every day.

4. In all 42,615 daily doses have been distributed and taken.

5. It is intended that these daily doses shall be taken for a period of three or four months, when it is probable that most of those infected will be free from the worms. Some will have to continue this treatment longer.

6. It is to be noticed that a certain number (58) of those infected are not under treatment. This is due partly to persons leaving the district, partly to refusals, etc. Considering the general character of persons dealt with such a small number of failures is a great testimony to the work of the Supervising Medical Officer, Dr. Howard.

7. This daily treatment has continued during the quarter under review, and at the end of July and during August the re-examination of those under treatment will be carried out and the effect of the treatment known.

8. In area A, including Albouystown to Meadow Bank, the census and the microscopical examination have been completed; 4,195 persons were counted, 3,765 were microscopically examined, and of these 2,251 were infected, or 59-8 per cent. No treatment has been carried out in this area pending communications from the Inter- national Health Commission, save in Meadow Bank, to which reference is made later.

9. No work has been done in area C, which includes the part of Peter's Hall District to the south of Providence.

* No. 53 in Miscellaneous No. 304.

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10. Sanitary work has been carried on in the special areas selected for treat- ment, mainly directed to minimizing the possibilities of re-infection from infected soil,

11. Special attention must be drawn to the fact that there are two special methods utilized in giving thymol for the expulsion of the hookworm, viz., the daily method and the weekly method.

12. The daily method consists in taking daily doses of small quantities of thymol for a long period (three to six months), and is the method largely used by Dr. Ferguson in his work on the estates.

13. The weekly method consists in taking a large dose of thymol once a week for a short period (two to five weeks) and is the method almost wholly used by the International Health Commission in the United States of America.

14. In area B, the daily method was adopted and is being carried out. I quote Dr. Howard's remarks: "Whatever improvements in physical condition which may come from the slow process of cure where the daily method is used are so gradual that they are not noticeable by the patient and any intercurrent illness which may occur during the treatment is immediately attributed to the thymol. These difficul ties are being demonstrated and are increasing daily in area B, where the daily method is being used exclusively. Here we started treatment in 1,860 cases. Of this number 150 have already abandoned treatment, either removing from the area or remaining as possible sources of infection. We have lost these cases in spite of infinite pains on the part of the Supervising Medical Officer, and we must face the fact that although the campaign in this area is not more than half finished eradi- cation is already 8 per cent. a failure. The only hope to eliminate these cases is to offer them the advantages of a speedy cure with the intensive method."

15. The expense of treatment is also an important item. Dr. Howard esti- mates that the daily method costs per capita from $1-40 to $1-80, while the weekly method costs per capita 40 cents to 80 cents, according to the density of population.

16. It is evident that Dr. Howard's experience leads him to favour the weekly method. Not only does the expense bring him to recommend the weekly method, but so also do the results.

17. In order to demonstrate the method of organizing and carrying out the weekly treatments, Dr. Howard dealt with the isolated village of Meadow Bank by this method.

His remarks are as follows:-" Compare with the above figures the results obtained in Meadow Bank where the intensive methods were used.

141 cases were cured with two treatments.

Only 12 required three treatments for cure.

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At the end of the fifth week, even though treatments were materially interfered with by church and social events, we have attained as nearly complete eradication

of ankylostomiasis in Meadow Bank as can ever be hoped for.

Of the positive cases available for treatment in this village only two have refused and only one has abandoned treatment.”

18. It is still too early to accept Dr. Howard's estimate and results as correct, and it is possible that the figures inay have to undergo considerable modification.

19. The total cost for the work done in area B during the quarter was $1,279-72 and in area A $15285, or a total of $1,432-57.

20. Detailed information as to the treatment, infection and cost will be found

in Dr. Howard's quarterly report attached. (Vide_ A.)*

21. A letter addressed by Dr. Howard to the Surgeon-General just before leaving, and summarizing his experience and general opinion, has also been included. (Vide B.)

22. Detailed information as to the sanitary work done is attached in a separate report. (Vide C.)

23. A gratifying feature of the campaign has been the ready and willing co- operation of those inhabiting the villages. The sympathetic attitude and painstak- ing care, in explaining and demonstrating the hookworm and its effects, both of Dr. Howard, the Supervising Medical Officer, and of Dr. Ferguson, his coadjutor, have achieved complete success, and have enabled the inhabitants to accept the treatment and realize the resulting benefits.

K. S. WISE,

Surgeon-General.

* Not printed.