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PUBLIC RECORD OFFICE

Reference :-

PERMC.O. 885

24 PUBLIC RECORD OFFICE, LONDON

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

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No. 32.

MR. WICKLIFFE ROSE (INTERNational Health COMMISSION) to Mr. H. R. COWELL (COLonial Office).

DEAR MR. COWELL,

(Received 18th October, 1914.)

725, Southern Building, Washington, D.C.,

1st October, 1914. DR. VICTOR G. HEISER, formerly Director of the Bureau of Public Health for the Philippine Islands, has been appointed by the International Health Commission as Director for the East. He will have charge of the Commission's business in that geographical division.

40449

No. 33.

Very sincerely yours,

WICKLIFFE ROSE.

MALAY STATES.

MR. WICKLIFFE ROSE (INTErnational Health Commission) to MR. H. R.

DEAR MR. COWELL,

COWELL (COLonial Office).

(Received 19th October, 1914.)

[Answered by No. 41.]

725, Southern Building, Washington, D.C.,

8th October, 1914. DURING my visit to Malaya I had opportunity to observe conditions from Penang to Singapore. I had conference with the Government and the medical authorities and visited hospitals and estates in many parts of the peninsula. Altogether I examined, clinically, one by one, about 2,000 coolies. The medical authorities are agreed that there is a prevalent ankylostome infec- tion among the Indian coolies on rubber estates. In some places this infection I found the probably runs as high as 65 per cent. of the coolie population. medical profession divided in opinion as to what this infection represents as a menace to health and working efficiency. After my personal observations I was not prepared to recommend expenditures by our Commission or by the local Government for systematic work for the relief and control of this disease on the basis of present facts. It was suggested that a commission be appointed to Since my return from the determine this question by scientific investigation.

East I have been maturing this suggestion. It meets with general approval.

2. On 2nd October the proposition was finally brought to the attention of our Executive Committee, and received formal approval. We are now authorized to proceed with the appointment of the commission and with the arrangements for undertaking work. It is thought that the work called for in the Federated Malay States will be called for also in a number of other Eastern countries where conditions seem to be similar.

3. I am enclosing copy of my letter to the Governor of the Straits Settle- ments, which will give you detailed information concerning the form which the proposition has finally taken. If the proposition should be approved by the Governor, by the Secretary of State for the Colonies, and by the English Advisory Committee, we are prepared to take up work at an early day.

Very truly yours,

WICKLIFFE ROSE.

SIR,

Enclosure in No. 33.

725, Southern Building, Washington, D.C.,

8th October, 1914. REFERRING to our interview at Government House in Singapore, concern- ing the advisability of appointing a commission of scientific men to determine by investigation to what degree ankylostome infection is a menace to health and working efficiency in the Federated Malay States, I beg to say that I have given

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much attention to the maturing of this proposition. On arriving at Manila I found Dr. Heiser, head of the Bureau of Public Health for the Philippines, much interested in this suggestion. His experience with the infection in the Philip- pines indicates conditions similar to those existing in Malaya, and raises the same question as to the degree of menace which it represents. He feels very strongly the need of having this question scientifically determined, and asks that if such commission be appointed its work be extended to those islands.

2. It is believed that the work called for in the Federated Malay States and

in the Philippines will be called for in other countries in the East.

3. Since my return to the States I have conferred with a number of our scientific men on this subject. Without exception they concur in the judgment expressed by the medical men with whom I discussed the subject in the Federated Malay States, namely: (1) That it is possible, by scientific investigation, to deter- mine the relative importance of ankylostome infection as a disease-producing entity, and (2) that it is highly desirable to have this question definitely settled before undertaking work on any large scale for the relief and control of the disease.

4. Dr. Heiser has recently accepted position with the International Health Commission as Director for the East. In view of his knowledge of conditions in the Far East I asked him to submit an outline of the project for this proposed Ankylostomiasis Commission. This project, copy of which I enclose, was presented to the Executive Committee of the International Health Commission on 2nd October. By action of the Committee we are authorized to proceed with arrange- ments for the appointment of the commission and for the beginning of the work. 5. It has been suggested that we have a commission composed of British and an advisable arrangement American scientists. This commends itself to us as provided the war has not already made too heavy demands on the British medical profession. It is thought desirable also that wherever possible a local investi- gator be attached to the commission in each country where work is to be done. It is expected, furthermore, that the commission will employ local clerical assistance. The International Health Commission is prepared to finance the work with such local co-operation in the way of supplying facilities as the Governments of the countries in which the work is to be done may desire to give.

7. It has been agreed that the work will be undertaken in the Philippine Islands. If you still approve the plan to have this commission work in the Federated Malay States, the Secretary of State for the Colonies approving, we are prepared to take up with you arrangements for beginning the work. Dr. Heiser sails for Manila 29th October. He could go to Singapore at an early day to confer with you concerning details. A line addressed to him at Manila would have his prompt attention.

8. I am sending copy of this communication for information to the Colonial Office and the English Advisory Committee in London.

Sir Arthur H. Young, K.C.M.G.,

Governor of Straits Settlements and High

Commissioner of the Federated Malay States,

Singapore.

PROJECT NO. 1.

I have, &c.,

[WICKLIFFE ROSE.]

The Ankylostomiasis Commission which it is proposed to appoint for work in the Federated Malay States and other countries.

1. For the Southern States and for Porto Rico we have abundant evidence that ankylostomiasis is a most important factor in the causation of disease. Reliable data on this subject are lacking in the Orient.

2. Experience in the Far East, especially in Malaya and in the Philippines, has caused considerable doubt as to whether hookworm disease is as important a factor in the health of the people as it is in other parts of the world.

3. There is a general disposition among health officials of the Orient to expend funds upon the suppression of disease about which there is more definite informa- tion available than there is about ankylostomiasis. Many of them regard the value of a hookworm campaign as problematical.

4. It is obviously desirable that a disease which has such great importance in the United States and Porto Rico, and which is known to prevail very exten- sively in the Orient, should be carefully studied in order definitely to ascertain its relative standing as a disease-producing entity.