CO885-(23-24) — Page 626

PUBLIC RECORD OFFICE

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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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Population of area B, Peter's Hall District, as shown by actual census taken by staff of International Health Commission Number examined for ankylostomiasis by the staff of the International Health Commission in area B... Number refusing examination, some removing from area, and others remaining as possible foci of infection

(or 10 per cent. of the population) In Meadow Bank village, area A, population as shown

by census

Examined

Number refusing examination or removing from village

(or approximately 10 per cent.)

3,503

3,207

350

520

467 53

2. The treatment of every individual affected with ankylostomiasis, until cured, depends upon the willingness of the patients to take the treatment for a sufficient length of time. Here, as in the question of microscopic examination, there are a small number who persist in refusing treatment, even though shown that they harbour the parasite.

There are others who abandon the treatment short of a complete cure, and a small number who are refused treatment for medical reasons, thymol being contra indicated because of intercurrent diseases.

The number that refuse or abandon treatment is usually smaller than the number refusing examination, as is shown by the following figures taken from the reports from British Guiana ---

Agricola, Peter's Hall District* :—

Positive cases reported, 20th July

Number starting treatment

Number cured

Number under treatment

Meadow Bank, area A, Peter's Hall District:

Number abandoning treatment

Number refusing treatment

Number positive cases reported

Number starting treatment

Number reported cured

Number abandoning treatment....

Number refusing treatment

019

619 311

239

69 (11 per cent.) Not reported.

275

211 209

(3.4 per cent.)

The difference between the number found positive and the number treated and cured will vary in proportion as the Supervising Medical Officer is patient, persistent, and tactful, or otherwise.

3. The installation of sanitary closets or latrines is possible, as has been demonstrated in parts of Peter's Hall District and elsewhere. Compulsory laws with penalties, if enforced, will secure results, but better, and much more to be desired, are the results obtained by a campaign of education and enlightenment, which creates a public demand for such improvements. After such closets are installed, we still face the difficulty of securing their use by the people. This is not, in my opinion, however, the hopeless task that some have expressed it to be. In Peter's Hall District, with its mixed population, consisting largely of ignorant blacks and East Indians, the patient, tactful, and yet firm handling of this question brought really remarkable results.

4. Efforts to protect the people from infection from the already existing ankylostomes in the soil are possibly less promising of success than any other feature of eradication.

Because of the labour involved it is often impracticable to attempt to locate areas where the soil is infected with the ankylostome ova and embryos. If such areas were located they would probably be too extensive to make their destruction possible, or to keep the people away from these infective points.

Attempts at the destruction of the ankylostome ova and embryos in the soil by the use of chemicals have not been entirely satisfactory. In a paper read before the Society of Tropical Medicine and Hygiene, by Sir Thomas Olliver, in 1910, the statement is made that "the one salt which has given the most satisfactory results

Campaign not yet completed.

57

all around is iron sulphute. It is estimated that one ton of this in a one per cent. solution would cover a length of sixty miles, more than a yard wide, and one-third of an inch deep." This solution was used to a limited extent in Peter's Hall District, and brush and trash piles were burned on spots likely to be heavily infected-such as sites of surface closets, stooling-places in thickets and in cane-fields, etc.

It is possible to meet the difficulties presented by this fourth and last essential to complete eradication by keeping the entire population under observation until sufficient time has elapsed for all ankylostome embryos in the soil to die probably about ten months or to arrange a return campaign, when cases resulting from re-infection from this source may be found and cured.

Summing up the situation, we may say that, while the complete eradication of ankylostomiasis in a given territory is theoretically possible, practically it can only be approximated.

What, then, are the results and benefits of a properly conducted campaign of this nature?

How nearly eradication was

1. Approximate eradication is obtainable.

approximated in British Guiana is indicated by complete returns from one village and partial returns from another.

Report from Meadow Bank village, Peter's Hall District, 15th August, 1914:

Of the 233 positive cases remaining in Meadow Bank village at

the close of the two months' campaign, 209 were cured. The 24 not treated are reported as follows:-

7 refusing treatment,

2 abandoning treatment,

15 were refused treatment because of pregnancy, or intercurrent

diseases contra-indicating the use of thymol.

Percentage cured, 90.

In Agricola village the campaign is not yet completed, but of the 619 cases beginning treatment, 311 are reported cured, and 239 are continuing treatment with prospect of early cures in practically all of this number.

We see from these reports that these campaigns mean the cure of a large percentage of those affected with ankylostomiasis. In Peter's Hall District it means the restoration to health and happiness of hundreds of severe cases, of all ages and degrees of infection ranging from physical unfitness to labour, and consequent poverty and want, to advanced bed-ridden invalidism. Scores of children whose mental and physical development were endangered will be free from the disease and restored to their natural heritage of buoyant health and vitality. It means the relieving of the mothers of the district from the dangers of a disease which, during preg- nancy and at childbirth, has enormously increased the maternal death-rate. 2. As a result of our campaign the increased activity of the sanitary authorities, together with the awakened interest of the people in improving sanitary conditions, have brought results which will lead to a marked decrease in typhoid, dysentery, diarrhoea, and kindred troubles.

"

3. The campaign was in this instance, as it generally is, a "pioneer movement,'

and "blazed out" and made easy the way for other crusades against prevent- able diseases which the future necessarily will bring.

4. If the following efforts be steadily continued:-

(a) To improve sanitation and stop soil-pollution;

(b) To educate the people concerning the cause and prevention of the

disease;

(c) To provide, after the close of the campaign, for the free treatment

of all cases of ankylostomiasis;

then it would seem reasonable to hope for eventual eradication, an end probably not attainable save by aiming at and striving for complete eradication during the initial campaign in any given community.