CO885-(23-24) — Page 621

PUBLIC RECORD OFFICE

Reference :-

PILL CO. 885

24 PUBLIC RECORD OFFICE, LONDON

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

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Other lectures were delivered at the schools of Agricola, and throughout the area, and one lecture especially for those who were unable to secure seats or standing-room at the opening lecture. Other informal talks were made at the dispensary, illustrated from time to time with the hookworm chart, and the ova and live embryos were shown under the microscope.

As the work progressed it became necessary for the Medical Officer to call in person on a number of the villagers and persuade them to co-operate, explaining to them that our sole desire was to render them a service without any cost to them. To secure publicity for the campaign, and to educate the people concerning ankylostomiasis, our efforts were directed through the following channels:-

1. Through local papers:-Articles dealing with ankylostomiasis in a simple way, that is, detailing its symptoms, its harmful effects, its prevalence, the methods of examination, the nature of treatment, the certainty of speedy cure, place and time of free examination, etc., were furnished to the local Press, and also printed in sheet form and distributed throughout the district.

2. Statements from medical authorities and Government officials endors- ing the work and asking for the co-operation of the people were secured and given wide publicity.

3. Illustrated lectures were delivered wherever a sufficient number of

people could be assembled.*

4. Special literature on ankylostomiasis illustrated with cuts showing

cases before and after treatment, etc., were distributed freely.† 5. The co-operation of village authorities, schoolmasters, clubs, baby- saving leagues, and Church organizations, was secured, and every worthful kind of local influence was enlisted in the campaign. pastors of the churches and the schoolmasters were especially helpful.

3. Census Taking.

The

In order to make effective any plan for the complete eradication of ankylos- tomiasis, the first steps are to secure a complete and correct census embracing all individuals within the field of operation; to record the personal history of each as to name, race, sex, and age; and to number or mark each house so that these individuals may be located at any time.

This in itself is a considerable undertaking, and was made more difficult in Peter's Hall District by the dense crowding of the people in some of the villages, and their tendency to shift and move about, many of them not having a permanent place of abode.

To take the census it was necessary to have men who could write legibly, and "Personnel of Force," who possessed some clerical ability. Under the chapter on it is provided that there shall be a male nurse and one assistant to each 1,200 inhabitants, for the purpose of administering the thymol. When the nurses and their assistants were employed care was taken that they should possess the quali- fications necessary to census-takers, since it was not only economy to have them thus employed before the actual treatment of cases began, but it afforded them an opportunity to get acquainted with the people.

Two of these went Each group of census-takers consisted of three people. together from house to house, recording names and personal history, inspecting latrines, numbering the houses, and delivering to each individual a properly- marked tin container, requesting that a small portion of the fæces should be On the following day the third man of the group called to collect placed therein. these specimens, and to take them to the central office for microscopic examination. We found that it is best in the villages to take the houses street by street, numbering them consecutively, for which purpose a heavy red oil crayon answers admirably. Form No. 1 in the Appendix shows a sample page of the field census- These books provide for 200 names, approximately book used in British Guiana.

* Charts for this purpose dealing with ankylostomiasis can be had from the International Through it also can be purchased a variety of Health Commission at Washington, D.C.

magic-lantern slides dealing with the same subject, which can be used to advantage in night lectures.

† The half-tones suitable for illustrations may be secured through the offices of the Commission. A one-fourth ounce container with paper inserted in the lid may be had from the Myers' They are inexpensive and in general use Manufacturing Company, Camden, N.J.

for this purpose.

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one day's work in census-taking. This arrangement allows the book to be handed in complete at the end of each day to be recorded, and also makes the names at once available for the use of the collector in gathering specimens for examination. Each day after the containers had been given out, the collectors in our work in British Guiana were able to secure about four-fifths of the desired specimens due. They were required to keep a list of the remaining one-fifth who were delin- quent, and to call from time to time until specimens were obtained from every individual.

4. Microscopic Examination.

After the specimens of fæces had been collected by the third man in the census group and had been brought to the dispensary, they were assorted with reference to the several villages from which they had been brought, and were then ready for microscopic examination. The microscopist was required to record the data appearing on the paper cover of each box before removing the cover, thus preventing confusion. The form used for the microscopical record sheet is shown in the Appendix.

The method of examination used in British Guiana and recommended is that detailed in Dook and Bass, "Hookworm Disease," pages 158-161. Briefly stated, it is as follows:-

One by three-inch slides are used. Place two or three drops of water in the centre of the slide and with a wooden toothpick take up a quantity of fæces about the size of the head of a match. Stir this into the water on the slides until it is cloudy, spreading out the diluted fæces over the surface of the slide at the same time. Care should be taken not to get the mixture too thick to allow rapid examina- tion and clear outlines. Should the first slide prove negative, another is prepared in the same way. No examination is recorded as negative until three slides have been examined, all failing to show the presence of the ankylostoma ova.

No cover-glass is necessary. Only wet preparations should be examined. A properly prepared specimen can be gone over thoroughly before drying out. The objective and 1-inch eye-piece, or the 16 millimetre objective and corresponding eye-piece, will give the proper magnification of about 100 diameters. It is well to have the objective also for demonstration and differentiation of doubtful ova. mechanical stage is not essential and not commonly in use in the work in the United States. That degree of skill is readily acquired which enables the microscopist to manipulate the slide with the fingers. When this method of examination is used more than 100 people can be examined daily by each microscopist.

The

Recently there has been put upon the market by Bausch and Lomb, of Rochester, New York, a specially constructed centrifuge,* which greatly simplifies the work of This is a hand- the microscopist, and at the same time secures greater accuracy.

These tubes are of drive machine with a Stewart pan-head carrying 20 tubes. glass, open at both ends, providing for the use of ordinary corks of the proper size. A piece of the fæces about the size of a bean is placed in one of the flat bottom vials which come with the outfit, and agitated with sufficient water. When in solution this is strained through coarse gauze into the centrifuge tube in order to remove large débris. The centrifuge tube is then corked and placed in position. Gummed labels are used on both the flat bottom and centrifuge tubes, with numbers corres- ponding to the numbers given to the names of the individuals on the record sheets, thus avoiding danger of confusing specimens. The tubes and funnels are easily boiled and the corks discarded after use. After the specimen is centrifuged all suspended débris (including all ova) is found deposited on the cork at the outer end of the tube. This is removed and the deposit is smeared on a 2 by 3-inch slide This mixture is on which have been previously placed several drops of water. uniformly spread over the surface of the slide and examined with a objective and 1-inch eye-piece without cover-glass or mechanical stage. The process is rapid, and is facilitated by having one or two cheap employees in the central office to do the centrifuging.

When the centrifuge is not used, it has been customary, as we have seen, to examine three slides before recording negative results. It is only necessary to examine one slide, however, with the centrifuge method, and more accurate results are obtained. Especially is the use of the centrifuge valuable in the re-examina- tions after treatment, where the eggs are often reduced to the minimum.

* Since these special centrifuges and supplies are not yet listed in the catalogues, a descriptive

list will be found in the Appendix.