435
PUBLIC RECORD OFFICE
Reference :-
PUBLIC RECORD OFFICE, LONDON
ALLY WITHOUT PERMISSION OF THE BE REPRODUCED PHOTOGRAPHIC-
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inauguration of the Work.
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Dr. P. W. Covington, who was appointed to direct the work in Antigua, arrived on 16th August. Field work was started 15th September.
Dr. Covington's first Monthly Report follows:---
First Monthly Report on the Amelioration and Control of Ankylos-
tomiasis in the York Valley District of Antigua.
St. Johns, Antigua, 1st October, 1915.
SIR,
THE time between my arrival, 16th August, and the arrival of my supplies, 13th September, was largely spent in interviewing Government officials, selecting from those applying the men most suited for positions on our staff, and in giving publicity to the work to be carried on in the York Valley District, the area which had previously been selected for the inten- sive community health work, this area, comprising the villages of Bolans, Roses, Jennings, Ebenezer, Darbys, and Blubber Valley.
(1) The following were appointed to fill positions on our staff:-
T. W. Moore, microscopist.
S. V. Atbill, microscopist.
Eugene Roberts, first nurse. Thomas Knowles, first nurse.
William J. Tulley, second nurse.
George Francis, second nurse.
Solomon Edwards, caretaker.
(2) The publicity given the work previous to its inauguration was as follows:-Personal interviews with many of the leading citizens in the villages of our area; an illustrated lecture at the Cedar Hall School-house at Jennings, and at the Wesleyan Chapel at Bolans, with an approximate attendance at each of four hundred.
(3) Upon the arrival of our supplies the York House, located near the centre of our area, was equipped as a field laboratory.
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repre- (4) After having divided the district into two areas, area "A
"B" repre- senting the villages of Jennings, Ebenezer, and Darbys, area senting Bolans and Roses, our field work was inaugurated 15th September.
A nurse, with his assistant, was placed in charge of each area. Their duties were, first, to number and take a census of each home, recording in a book provided for that purpose the name, age, sex, and race of the occu- pants of each household, and to furnish to each a container upon which had been written their name, age, and house number. On the following day these specimens are collected and carried to the field laboratory, where the microscopic examinations are made. Certificates are given to those found free of infection stating this to be the case; with those infected arrange- ments are made to treat them on a day most suited to their convenience. All are visited by the Director in charge to determine their physical condition before being treated.
(5) Four smears are examined from each negative specimen, two before and two after being centrifugalized. The results of all examinations are veri- fied by myself. Because of the inexperience of our microscopists the examinations have progressed necessarily slow.
(6) The following tabulations give a summary of the work from its inauguration, 15th September, to 30th September :-
Jennings.
Bolans
Total.
Number homes surveyed ...
122
154
276
Number containers distributed
509
655
1,164
Number specimens collected
501
494
995
Number infected with Ankylostome
duodenale
108
91
199
Percentage of infection
241
28
25
Number infected with ascaris
215
182
397
Percentage of infection
481
57+
51
Number infected with tricocephalus
147
165
312
Percentage of infection
331
52
41
(7) Of the two hundred and seventy-six homes visited only nine have
latrines.
These are of "D" type..
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(8) No treatments are recorded. The first to be given will be in October. In this report we have mentioned only the medicinal phase of the work, inasmuch as the Government of Antigua is to carry on the sanitary part of it, such as draining and cleaning off the undergrowth around the villages and the building of suitable latrines, so that further soil pollution will be prevented.
I have, &c.,
Dr. M. P. Duke,
Supervising Medical Officer,
St. Johns, Antigua.
P. W. COVINGTON.
As indicated in the previous, the York Valley District was the area selected for operation. This area, which is roughly two miles in diameter, embraces the villages of Darbys, Ebenezer, Jennings, Blubber Valley, Roses, and Bolans; later the villages of Yorks, Hermitage, and New Division were added. The combined population of these villages is 1,957.
The York Valley District was the first area selected for the eradication of ankylostomiasis by the intensive method, because:--
(1) A preliminary survey by Dr. Marshall had shown the percentage of infections with Ankylostome duodenale to be comparatively high in this district
(2) The population of the area was considered appropriate for the beginning of the intensive method in Antigua.
(3) It is a district with natural boundaries. The inhabitants of this area are practically all negroes. Some of them are indifferent towards anything done for the betterment of their condition, such as this campaign. The homes of many of these people are mere hovels, which are kept in a very insanitary condition by the occupants. Some of the people are quite nomadic in their habits, so that we may lose a number of patients because they move out of the area, and we may add some new comers to our original census.
III. Preliminary Educational Campaign.
In beginning the work in York Valley District an inaugural meeting was held, at which His Excellency the Acting Governor of Antigua presided. Addresses were delivered by Dr. Duke, Dr. McDonald, and Dr. Covington. Lantern slides relating to hookworm disease were projected on the screen and used to illustrate the ravages and the prevention and cure of the disease. Following this, other lectures illustrated by lantern slides were given at various schools in the area.
A campaign against ankylostomiasis to be successful must be given publicity. This is done by (1) interviewing with the influential people of the community: (2) by means of printed circulars describing hookworm disease and the campaign against it (3) by means of lectures.
In the York Valley campaign all of these methods were employed.
A total of sixteen lectures were given, and there were distributed about two thousand circulars describing hookworm disease.
IV. The Force engaged in the Work.
The force engaged in the work of eradicating ankylostomiasis consists of (1) the Director, (2) two microscopists, (3) three nurses and assistant nurses, (4) a varying number of supernumerary nurses who are engaged for Sundays only, (5) a caretaker.
The duties of the microscopists are to make thorough microscopical examina- tions of all specimens of fæces received and to assist in keeping the office record.
The duties of a nurse are :---
(1) To give publicity to the campaign in his district by distributing circulars describing ankylostomiasis.
(2) To enumerate all the persons residing in his district, and to record the name, age, race, and sex of each person.
(3) To make sanitary survey of his district, recording the type of latrine used
by each household.
(4) To collect from each person in his district specimens of fæces and bring these to the laboratory for examination.
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