CO885-(23-24) — Page 623

PUBLIC

RECORD OFFICE

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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Our experience in British Guiana with the two methods of treatment demonstrates the fact that :-

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1. The "intensive treatment presents less difficulty as an administrative

problem.

2. It cures a larger percentage of those infected.

3 These cures are secured at a smaller per capita cost,

For the foregoing reasons only the patients in the first area of Peter's Hall District will be treated by the "daily" method, in all other areas the "intensive" treatment will be employed.

From Report of 15th August, 1914.

Method of treatment used

Duration of campaign

Population examined

Number infected with ankylostomes

Number beginning treatment

Number

cause

refusing treatment

without

Number to whom treatment was refused

for medical reasons

Number abandoning treatment, some re-

maining and others removing Number removing before treatment

started

Number remaining to be treated...

Number died (not associated with ad-

ministration of thymol)

Number cured

Under treatment

Unaccounted for

+

Agricola. Meadow Bank.

"Daily." "Intensive."

3 months* 2 months†

1,231

520

619 (50%) 275 (52%) 619‡ 211

7

15§

78 (11%)

2 (less than 1%)

34|| 240

2

1

303 (49%) 209 (87%)

236

0

0

7

The campaign was unduly prolonged by church festivals and sanitary work in progress in the village.

6. Re-examination.

As complete eradication aims at writing "cured" after the name of every infected individual in the area of operation, re-examination after treatment to ascertain who are "cured" is an important step in the campaign, and the methods used should be such as to insure unquestioned accuracy in the results. Our experi- ence in British Guiana shows that certain general, but none the less essential, rules should be followed:-

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1. No negative results, or cures," were accepted as such unless the speci- men of fæces was secured at least six days after the last dose of thymol was given to the patient. This precaution is rendered necessary from the fact that the toxic effect of the thymol on the female ankylostome continues for some days after its administration to the host, during which time the absence of ova will be misleading. This applies to the use of the small "daily" dose as well as the much larger dose of thymol used in the "intensive" treatment. The use of a specially constructed centrifuge accommodating twenty specimens, and operated by hand, which can be had in the American markets, will greatly facilitate this stage of the work.

2. Re-examinations with the "daily" small dose method were made at the end of the third month, and monthly thereafter until negative results were obtained. Each time the patient was required to omit the thymol a week prior to examination.

* Campaign not complete. + Campaign complete.

•

Figures not available or not verified.

For medical reasons:-Pregnancy, 8; lunacy, 8; chronic dysentery, 1; chronic diarrhoea and

ald age, ,"2; biliary cirrhosis, 1.

These removals were due in the main to the rigid enforcement of sanitary regulations.

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3. Re-examinations with the "intensive" method of treatment were made on the sixth day after the second weekly treatment, and weekly there- after until the patient was cured. This arrangement permits the patient to have treatment on the same day of each week, and yet allows a sufficient interval between the examination and the last dose of thymol.

4. It is recognized that there is a possibility of error in a small percentage of cases if the negative results of one examination are accepted as final. This possibility of error arises from the fact that, while the fæces of a patient may show no ova at the time of examination, there can be numerous ankylostome embryos in the tissues of the body, en route to the intestinal canal, as a result of a recent skin infection. Some weeks must elapse before these worms can reach the intestinal canal, grow to adult size, and begin to ovulate. Only repeated examinations, at intervals, as long as there is possibility of infection, will eliminate these cases.

It is obvious to anyone with laboratory experience that the use of the centrifuge will secure much more accurate results than those reached without it, and this is especially true in cases of mild infection, and partially cured cases met with in re-examination, where the numbers of ova are reduced to a minimum. Centrifuges operated by hand are usually constructed to handle two or four specimens, with tubes of such shape as to render it difficult to sterilize them. To attempt to use an instrument of this type means a great loss of time. It was to meet our needs that the specially constructed centrifuge mentioned in a preceding chapter (4. Microscopic Examinations, page 47) was offered.

This instrument accommodates twenty specimens. The tubes are plain glass, open at both ends, and can be quickly sterilized by boiling. Its use not only secures greater accuracy, but also greater speed in making the examinations.

7. Working Force.

In the beginning of the work in Peter's Hall District the force consisted of one black, who had some training in sanitation, and the representative of the Inter- national Health Commission. There were no additions made to the force until the publicity work was done, when there were added two young East Indians as microscopists, and a coloured man as pioneer. With these additions, the taking of the census began. Thus at each successive step of the campaign the force was developed and added to, and methods carefully tested out, until we recognized a definite personnel adapted to a definite programme, and able to carry it out economically, thoroughly, quickly, and efficiently. The following statement indicates the force employed for Peter's Hall Medical District:-

One Supervising Medical Officer, salary $1,600.00. One chief clerk, salary $65.00 to $80.00 per month. One assistant clerk, salary $20.00 to $30.00 per month. Three pioneers, salary $15.00 to $20.00 per month, each.

To each 1,200 inhabitants :-

One male nurse, salary $30.00 to $40.00 per month. One assistant nurse, salary $8.00 to $12.00 per month.

To every 4,000 or 5,000 inhabitants :—

One microscopist, salary $20.00 to $30.00 per month.

The male nurse referred to above was usually an East Indian or black who had seen service either in the Government hospitals or those of the sugar estates. Whenever possible, these men were secured in the district where they were to work. Their service in the hospitals had given them a certain amount of prestige in the minds of the people, who readily accepted their services in giving the thymol treat- ment. The nurse and his assistant took the census in the beginning of the work, and collected the specimens of fæces for examination.

When the time came for giving the treatment the nurse and his assistant were furnished with a treatment book (see form in Appendix), in which were recorded the names of all who had ankylostomiasis. These people were seen in their homes, and arrangements were made with each individual as to the day of the week on which he or she preferred to take treatment. It was found that a nurse could handle about 50 cases each day, and his assistant the same.

These men called at the homes of the patients on the afternoon of the day before the treatment, administered the preliminary purge, and gave directions about

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