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SIR,

R

Enclosure in No. 3.

Surgeon-General's Office, Georgetown,

Demerara, 11th March, 1916.

I HAVE the honour to submit the report* of Dr. Field, the Supervising Medical Officer of the International Health Commission, on the amelioration and control of ankylostomiasis in the Belle Vue District, West Bank, Demerara River. 2. The report deals very fully with all aspects of the work and gives a wealth of valuable information in the statistical tables.

3. The object attempted, as in the Peter's Hall District, was the systematic examination of all persons in the villages of the Belle Vue District and the expulsion of all hookworms from those infected.

The result has been a great reduction in the number of persons infected (from sixty-nine per cent. to twenty-two per cent.-vide paragraph 40), a reduction in intensity of individual infection of those not cured, and a marked amelioration of symptoms due to hookworm infection.

4. Great care has again been given to the accuracy of the microscopical examination, and every effort has been given to make it complete and exhaustive.

5. The campaign began on 15th January, 1915, and ended on 31st December, Most of the work was completed by the end of September, 1915, but special efforts were directed during the last three months to collecting and treating the small residue outstanding at that date.

1915.

6. Special attention has been devoted to the indispensable sanitary work, with- out which the value of the campaign would be greatly diminished. It is not easy under any condition to change the primitive customs of 12,000 people and wean It has been found them from habitual surface defecation to the use of latrines.

impossible to carry out this essential work in the same time as the campaign of treatment, and whereas the Commission began work on 15th January, 1915, and finished on 31st December, 1915, the sanitary work began in May, 1914, and is still in progress.

7. While the officers of the International Health Commission have given valuable assistance in explaining to the people the necessity for suitable latrines and persuading them to adopt and erect such, the actual work in the entire district has been done by the Government Public Health Department.

8. Certain communities have been found more ready than others to adopt latrines, but in general the Public Health Department have found it necessary to enforce their persuasions by the serving of notices and at times by seeking the penalties of the law.

9. Having enforced the erection of latrines it is not all that will then use them, and it is known that defecation still takes place on the open ground. Such difficulties, however, will gradually disappear.

10. As a result of the work of the Government Public Health Department, about 1,400 new latrines have been erected. In addition many of the main drainage canals have been dug out, cleaning and weeding of individual lots have been carried out, screening of tanks and barrels, and inspection and cleansing of provision shops and bakeries, enforced.

11. It is of interest to note that, from the Peter's Hall and Belle Vue Districts, where the International Health Commission has now carried out cam- paigns, the number of persons seeking medical relief at the Public Hospital, George. town, has been much reduced, whereas the number from the city and from country districts where no campaign has been instituted has increased.

12. I again have pleasure in recording the perfect harmony which exists in the relation between the officers of the International Health Commission and the people amongst whom they work.

The Honourable

The Government Secretary.

* Not reprinted.

I have, &c.,

K. S. WISE,

Surgeon-General.

41897

7

No. 4.

ST. LUCIA.

REPORT BY DR. S. BRANCH ON THE WORKING OF THE HOOKWORM ERADICATION CAMPAIGN IN ST. LUCIA DURING THE HALF- YEAR ENDED 30TH JUNE, 1916.

(Received in Colonial Office, 31st August, 1916.)

International Health Commission Office, Micoud Street,

Castries, St. Lucia, 11th July, 1916.

SIR,

I HAVE the honour to submit, for the information of His Excellency the Governor, the Acting Director for the West Indies, and Your Honour, the follow- ing report, with tables and appendices, on the working of the hookworm eradication campaign in St. Lucia during the half-year ended 30th June, 1916.

The area of campaign was a direct continuation of that worked in the previous half-year. It extended through the rest of the town of Castries, as far as and including the western side of the Chausseé; at the same time we made a sweep from the Quatre Chemins through Petit Rocher and the waterworks back to the town boundary. This suburban extension completes about three-quarters of the water- shed of the Castries River and a similar portion of the Castries basin. remainder of the valley, lying on the slopes of Morne Dudon, La Penseé, Mount Pleasant, and Barnardville will fall under the campaign of the following half-year. The area was divided into four sections, each section under control of an individual nurse. The suburban extension above alluded to formed a section

The

by itself.

It is gratifying to me to have to report that I have had no reasons to make any change in the personnel of the staff. The nurses have worked hard and conscien- tiously, in spite of many trials among the populace of the East End" of Castries. At the start of the year I gave instructions that all medicines were to be personally administered by the nurses. This has caused delay, but has been very effective in curtailing waste of thymol. and, I think, improving results.

We are certain that the number of persons who have received first and every subsequent treatment have in reality swallowed the thymol, and that capsules of thymol are no longer collected and carefully put away in some secret part of the cottages. After months of weary waiting, but especially through the help of the Director, Dr. Howard, we received a centrifuge and its complete equipment in January. This has been of the greatest service in expediting examinations and helping to eliminate errors. Our present technique is to centrifuge after the second slide has proved negative; for the centrifuge a coarse unstrained emulsion is used; and three slides of the centrifuge emulsion must be examined before a negative can be registered.

The out-patient department is still carried on from the central office, and continues to do useful work educationally and medically.

All persons travelling third class from St. Lucia to New York by the Quebec Steamship Company are required to produce certificates that they are free from hookworm infection. This quarantine restriction has been a valuable advertise- ment, and no one likes to risk the penalty of being returned as an undesirable owing to his possession of this intestinal parasite. We willingly examine and issue certificates, either that the applicant is uninfected or has been treated and cured.

On 19th June the functions of the Local Advisory Committee for the cam- paign against ankylostomiasis (hookworm disease) were vested in the Board of Health of the Colony. In the official Gazette of 1st July it was published that the Board of Health had become the Local Advisory Committee for the campaign. The Administrator is Chairman, and two influential landed proprietors were added to the Board. At the same meeting at which this change was brought about additional regulations were passed, by which it is hoped to have more than a moral support for the installation of pit-latrines in each area as it is worked.

A

For the first time I have tried oil of chenopodium as a curative agent. sample of twenty-four capsules of eight minims each was sent to me by the Mulford Company. The experiment has been on too small a scale to form any definite con- clusions. It has been quite efficacious in expelling the worms and producing cures ;