PUBLIC RECORD OFFICE
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EPEREC.O. 885
24 PUBLIC RECORD OFFICE, LONDON
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11. Per Capita Cost.
In estimating the per capita cost of a campaign for the complete eradica- tion of ankylostomiasis, we are unfortunate in not having a full report of a cam- paign dealing with a large area. From such a report definite data could be obtained. The campaign in Peter's Hall District, British Guiana, however, does afford us complete returns from a small area, and partial returns from a larger area, and it is possible, by basing our estimates upon these, to arrive at results accurate enough for all practical purposes.
For our purpose here we will take the "Unit of Area of Operation”---a medical district-with a population of 15,000, and an infection of fifty per cent., and arrange a definite budget for this area.
Running Expenses:
Budget.
Medical district, population 15,000. Infection, 50 per cent.; 7,500 to be treated. Duration of campaign, four or six months.
Method of treatment, "intensive.'
Force and salaries:--
Monthly.
1 Supervising Medical Officer
$150.00
Four months. 8ix months. $600.00 $900.00
House allowance
20.00
80.00
120.00
Travelling allowance, limited
50.00
200.00
300.00
1 chief clerk, salary
80.00
320.00
480.00
1 assistant clerk, salary
25.00
100.00
150.00
3 microscopists at $30 per month
90.00
360.00
540.00
3 pioneers at $18 per month
54.00
216.00
324.00
6 nurses at $30 month
per
180.00
720.00 1,080.00
6 assistant nurses at $10 per month
60.00
240.00
360.00
3 caretakers for office at $5 per
month
15.00
60.00
90.00
4
3 offices at $6 per month
18.00
72.00
108.00
Contingent expenses for three
offices at $10 per month
30.00
Total of running expenses $772.00
120.00
$3,088.00
180.00
$4,632.00
Rate per capita 7,500 people to be
treated
.103
Rate per capita 15,000 people to be
examined
.052
.412
.207
.616
.308
Fixed expenses :-
Furniture and utensils for three offices: 9 tables, 18 chairs, 6 benches, water cooler, towels, etc. Additional for central office: typewriter, $80.00; locked press for record books, microscopes, supplies, etc., $20.00
$150.00
100.00
Scientific supplies: 3 microscopes at $35.00, Bausch &
Lomb, Rochester, N.Y. (special)
105.00
Microscope slides
10.00
1 Balopticon and tank, $35.00, Bausch & Lomb,
Rochester, N.Y.
35.00
50 Balopticon slides on ankylostomiasis, P.M. Foltz,
Washington, D.C.
15.00
1 hookworm chart
5.00
1 centrifuge (special), Bausch & Lomb, Rochester, N.Y. Accessories for same
15.00
5.00
1 kodak or camera
25.00
Printing: record books, report sheets, literature, etc.
300.00
Tin specimen containers, Meyers' Manufacturing Com-
pany, Camden, N.J. (150 gross)
75.00
Thymol: 180,000 5-grain capsules, average 24 capsules
to case treated, $2.50 per month
450.00
Sulphate of magnesia
75.00
Total
$1,365.00
Rate per capita for 7,500 individuals treated Rate per capita for 15,000 individuals examined
.182
.091
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In a four months' campaign running expenses give a per capita cost of $.412 for cases treated. Add to this $.182, the per capita cost of cases treated for fixed items of budget shown above, and we have a total per capita cost for cases treated during a four months' campaign of $.594. A six months' campaign would increase this to $.798.
12. Is Complete Eradication Possible?
There is probably no disease, certainly no other parasitic disease, of which our knowledge is so complete as it is of ankylostomiasis, and for which we have two or more specific drugs. There is not a missing link in our knowledge of the ankylostome, from the moment the egg reaches the soil in the fæces of its host and hatches into the embryo, throughout all the stages of development until, in its "encysted" stage, it enters the human body, to reach finally the small intestine, there to live for eight or ten years, reproducing its kind in countless thousands. Every detail of its life-history and the necessary environments for its development are points rendered very familiar by the researches of the scientist.
With such perfect knowledge, then, it has been an easy task to elaborate a perfect theory for the prevention of the disease. Only one thing is necessary- that is, to prevent soil-pollution; in other words, to keep the ankylostome ova from reaching the soil where it could hatch and develop into the infective embryo.
If those who have the disease can be cured and we know how to prevent others from contracting it-then complete eradication is at least theoretically possible
Let us consider briefly what are the necessary steps to accomplish complete eradication:-
1. The microscopic examination of every individual in the field of
operation.
2. The treatment of every infected individual until cured.
3. The installation and use of proper closets or latrines, preventing
further "soil-pollution."
4. The protection of the people against infection by ankylostome embryos
already in the soil.
Although the problem of complete eradication seems simple when thus put upon paper, it is not found so when actually attempted, for many difficulties develop. Every difficulty, however, can be rightly attributed to one cause--" lack of adequate co-operation on the part of the people." This lack of co-operation was evident from the first day of our campaign until its close, and since human nature is much the same the world over, this will probably be true in some measure, no matter where the campaign be waged.
Taking up the four essential steps to complete eradication, let us briefly note some of the difficulties which make against complete success :---
1. The microscopic examination of every individual in a given area of any extent has never been possible, in the experience of the writer. There have always been those few though they may be who refuse to submit specimens for examination. Widely varying reasons are advanced by these people for their failure to co-operate, and it may be of interest to mention those most frequently met with in Peter's Hall District :-
(a) A false sense of modesty prevented some from preparing and sub-
mitting specimens.
(b) People of apparent good health, though they might have mild infec-
tions, did not feel the need of examination and treatment.
(c) Among the illiterate class unreasonable suspicion and superstition
deterred some.
(d) Others, because of social prominence, intellectual attainments, or
wealth, seemed to consider themselves immune to the disease.
(e) There were some who were openly hostile, seeming to see in the cam-
paign an attempt to interfere with their personal liberties.
(f) The indifferent and negligent class furnished its usual quota of
incorrigibles.
The following extracts from the reports of Peter's Hall District for 15th August, 1914, show the number refusing examination :—
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