CO885-(23-24) — Page 609

PUBLIC RECORD OFFICE

Reference :-

mnïimmm C.O. 885

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

24 PUBLIC RECORD OFFICE, LONDON

SIR,

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(B.)

St. Huberts, 15th July, 1914. In response to your request for my opinion of the ankylostomiasis eradica- tion campaign from an administrative point of view, I have the honour to submit the following:-

Preliminary work. In outlining any plan of procedure which has for its end the eradication of ankylostomiasis, the first step is to secure a complete and accurate census embracing every individual within the territory to be operated in-record- ing personal history as to sex, age, and race--numbering each house-and at the same time an inspection of latrine accommodation can be made to ascertain the extent of soil pollution. When the census is being taken tin containers marked with the name, age, and house number are given to each individual for the purpose of securing a specimen of fæces for microscopical examination. This preliminary work is greatly facilitated if it is preceded by a campaign of education consisting of illustrated lectures on ankylostomiasis and the distribution of appropriate litera- ture. These specimens of fæces are collected on the day following the delivery of the containers, and are subjected to microscopical examination for ova.

The methods of microscopical examination now in use on the East Bank are accurate and rapid, being the result of wide experience. A competent microscopist can easily examine one hundred specimens daily. As soon as a large percentage of the population has been examined, treatment of infected cases should begin.

Treatment.-There are two methods of treatment to be considered in this Colony-the so-called daily method and the weekly or intensive method.

(a) The daily method consists of giving the patient ten grains of thymol each day, without purgatives or restrictions in diet or habits, for a period of four

months.

(b) The intensive method is the giving of comparatively large doses of pul- verized thymol (40 grains to adult), in capsules of weekly intervals, preceding and following each weekly treatment with a saline purge, and requiring the patient to abstain from food for three meals. Attached hereto find a printed slip giving full It was by using this directions for the administration of the intensive method. method of treatment in Meadow Bank village that more than 50 per cent. of cases treated were cured by the first and second treatment, or on the eighth day from the opening of the campaign in that village.

As to the special method of giving the thymol, as indicated by the printed slip of directions, I will say that there is a scientific reason behind each step of the treatment, which must be evident to the mind of the medical man who is familiar with the disease, and the results will be uniformly satisfactory in exact propor- tion to the care with which these directions are followed in the administration of the thymol.

Ankylostomiasis is not a disease which can be cured by haphazard medication, nor is thymol a drug which can be safely used in an efficient dose except with care, and under certain definite restrictions. The selection of a method of treatment to be used in total eradication, or wherever a large number of cases are to be dealt with, can not be made with too much care, for in the ultimate result, whether it be success or failure, the method of the administration of the thymol will always remain the most important factor.

In the light of our experience on the East Bank, where every detail of the work has passed through my hands, and where I have devoted nearly four months of care and painstaking attention to the attempt of making the daily method of treatment a success, it has been settled, to my satisfaction at least, that this method is not available in dealing on a large scale with the village population, with whom any degree of compulsion is impossible. I can quite understand how the daily method has been in a measure successful in Dr. Ferguson's hands on the estates of the East Bank. The problem which he had to solve was quite different, time was not an item, his operations were with a limited number of indentured East Indians who were under firm discipline and amenable to it, and who submitted to the daily dosing with thymol whether willing or not. No census was necessary, the necessary force for distribution of the thymol already existed, as did the necessary clerical help to record results, and so the cost of his work was limited to the cost of the thymol, and this expense was six times the amount necessary to accomplish the same results with the intensive method of treatment.

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As to comparative cost of the two methods I beg to call your attention to the two budgets submitted herewith for area C, Peter's Hall District. One provides for the entire campaign with the intensive method, and the other deals with the daily method in the same manner. As these budgets provide for the same area under similar conditions, they afford opportunity for comparison, These budgets are based upon actual experience and will work out fairly accurate in practical appli- cation. Far more important than per capita cost is the question of the degree of eradication possible with the respective methods.

It is obvious that the longer the course of treatment for the individual case the more likely the course of treatment is to be interrupted, and also the larger the number who will abandon the treatment before cured.

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 difficulties are being demonstrated and are increasing daily in area B, where the daily method is being Of this number 150 used exclusively. Here we started treatment in 1,860 cases.

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 eradication is already 8 per cent. a

failure. The only hope to eliminate these cases is to offer them the advan- tages of a speedy cure with the intensive method.

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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four

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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.

Administration of the intensive method. The plan followed in Meadow Bank village has many advantages, and is economical. It was this plan which has been used in formulating budgets for areas A and C.

It provides for one sick nurse at $30.00 per month and one assistant distri- These men are used in butor at $8.00 per month to each 600 cases to be treated. the beginning to take census, deliver containers, and collect specimens. They are expected to attend, each, a certain list of patients during the day of treatment, giving the saline purges and thymol at the proper hours and attending to the restrictions of diet.

By referring to the budget submitted for area A it will be noted that 800 cases are allotted to each sick nurse and assistant. This increase was made possible by the density of the population in this area.

These men are furnished with distribution books in proper form upon which they record each day's work.

Re-examinations, with the intensive method, begin the second week of treat- ment or after the second treatment has been given. Specimens are collected by the nurse and assistant at least six days from the last dose of thymol. The reason for this interval is that it has been found that the female worms which are not dis- lodged by the treatment do not resume their procreative functions for several days after the giving of thymol. In all re-examinations the plan will be adopted soon of centrifuging the specimens. This will promote accuracy and obviate the necessity of requiring two negative examinations made at intervals before a recorded.

cure

is

As for plans when eradication work is to be carried into new territory, I would suggest, from the standpoint of economy, that it will be best in most instances to use the medical district as the unit. This might not be possible in large districts with small and scattered populations because of the distances involved, but it would be well always to establish a central office in the centre of the area to be operated in; here most of the clerical work, etc., will be done, the larger record books kept., etc.

PUBLIC RECORD OFFICE

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