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Reference :-

C.O. 885

24 PUBLIC RECORD OFFICE, LONDON

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

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5. Each Health Department in the Orient has been more or less expecting some other country to furnish a reliable scientific report on this matter, with the result that so far no progress has been made.

6. In the Philippines, for instance, there was much reason for believing that the elimination of hookworm among 3,000 prisoners reduced the mortality rate from 70 per thousand to 12 per thousand per annum, and that there was a great improvement in the health of the prisoners. Extensive investigations made later among the general population in many places in the provinces, which comprise more than 50,000 stool examinations, seemed to show that hookworm is important factor in the causation of disease, or that it influenced the mortality directly or indirectly. Experience in Malaya and in tropical Australia indicates that perhaps similar conditions may exist there.

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7. In view of the foregoing conflicting data, it is believed to be most impor- tant to bave an independent commission--one that comes with no preconceived ideas-undertake this work rather than to depend upon the health organization of a country. Such a commission could collect the data and could work in a number of different countries. It is believed that data thus drawn from many different sources would be of great value to all the countries of the Orient. It would prob- ably be found desirable to have the commission collect such data from Ceylon, Siam, the Federated Malay States, the Philippine Islands, and Indo-China. Some of the work could no doubt be done, in accordance with the suggestions of the commission, by the country directly interested. The report of such a commission would in all probability be of great assistance to the health organizations in the countries mentioned above, and in addition the data would be very useful to Java, German and British New Guinea, tropical Australia, and other countries located in the Orient in the latitude of the countries in which the commission worked.

8. The commission should also attempt to furnish a solution for the problem as to whether race or geography is the more important factor. For instance, is a negro less affected by the disease than a white man or a Malay, or is environment the more important element? In order satisfactorily to study this matter, it might also be necessary for the commission to undertake a certain number of investiga- tions among the inhabitants of New Guinea, who are more of the negroid type and fairly representative of all the Pacific Islanders each [ east] of longitude 1350.

9. If this proposition to appoint such an Ankylostomiasis Commission should be approved by the Executive Committee of the International Health Commission, the Director for the East would confer with the Government of the Federated Malay States with a view to making arrangements for the commission to begin its work in that country. This would involve, among other things, the selection of a place and the buildings in which the work is to be done, arrangements for the supply of patients, both through Government agencies and the rubber estates, and from such other sources as may be deemed advisable. Well in advance of the time that the commission terminates its labours in the Federated Malay States the Director for the East will have visited other near-by countries, and will have made arrangements for the commission to begin work in such countries if such course is deemed advisable.

10. If, after conference with local officials and with the commission, it is deemed possible to carry on as a secondary project an investigation into measures for the suppression of malaria, the Director for the East will carry out such project.

40785

No. 34.

BRITISH GUIANA.

THE DIRECTOR, INTERNATIONAL HEALTH COMMISSION, to MR. H. R.

DEAR MR. Cowell,

COWELL (COLONIAL OFFICE).

(Received October 21st, 1914.) [Answered by No. 38.]

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

10th October, 1914.

I AM enclosing copy of manuscript and covering letter which I am sending to the Surgeon-General of British Guiana. This letter and manuscript are self- explanatory. I should be greatly obliged if you would submit this to your Advisory Committee and get their judgment concerning the advisability of its use as indicated in the letter to the Surgeon-General of British Guiana.

Very sincerely yours,

WICKLIFFE ROSE.

SIR,

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Enclosure in No. 34.

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

10th October, 1914.

I AM enclosing for your criticism copy of a paper which has just been prepared by Dr. Howard. This is intended for publication and free distribution to persons engaged in the work in the various fields. Since it is based on work done in British Guiana, we should not care to publish it without your hearty approval of all details. I should be greatly obliged, therefore, if you would look the manu- script over and give me the benefit of your criticism of details and your judgment as to the advisability of using it as indicated.

Thanking you in advance for your co-operation in the matter,

Surgeon-General K. S. Wise,

Georgetown, British Guiana.

I am, &c.,

WICKLIFFE ROSE.

THE ERADICATION OF HOOKWORM DISEASE. INTRODUCTORY NOTE.

THIS pamphlet has been prepared in answer to numerous requests, received from both official and private sources, for information regarding the administrative problems of the work of the eradication of ankylostomiasis.

From a knowledge of the methods in use during the last four years in ankylos- tome eradication in the United States, together with the experience gained in the introduction and establishment of the work in British Guiana, the attempt has been made in these pages to place at the disposal of any who may be interested the resulting considerations. It is hoped that they may be of value in the introduc- tion of the work into new territory, where they may serve, if in no other way, as a starting-point from which better methods may be developed and perfected.

Special attention is called to the forms* which appear in the last pages. most important that an accurate, comprehensive, intelligible record be made of all work done. The forms submitted show how this was done in British Guiana. The methods set forth have met the test of practical application, and would seem worthy of trial wherever such work is to be undertaken.

Washington, D.C.,

15th September, 1914.

Respectfully,

It is

H. H. HOWARD, M.D.,

Director for the West Indies.

THE ERADICATION OF HOOKWORM DISEASE.

This subject is discussed under thirteen heads, indicating the successive steps

in the development of the work, as follows:-

1. Selection of Unit of Area of Operation.

2. Publicity and Educational Measures.

3. Census Takings.

4. Microscopic Examination.

5. Treatment.

6.

Re-examination.

7. Working Force.

8. Financial Procedures.

9. Duration of Campaign.

10. Sanitary Measures for Prevention.

11. Per Capita Cost.

12.

Is Complete Eradication Possible?

13. Forms and System of Reports.

• Not transmitted to Colonial Office,