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PUBLIC RECORD OFFICE

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Reference :-

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PUBLIC RECORD OFFICE, LONDON:

ALLY WITHOUT PERMISSION OF THE BE REPRODUCED PHOTOGRAPHIC-

COPYRIGHT PHOTOGRAPH-NOT TO

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one of its first acts was the sinking of the pit at Marchand, which is described by This pit having proved a success, the Dr. Branch in the report now forwarded. Department is making arrangements for the sinking of other pits in the areas men- tioned by Dr. Branch, and as recommended by the joint committee in their report.

3. Provision for the additional barge to be used as a refuse depôt for the north harbour end of the town is being included in the financial Estimates for 1917-18.

4. I propose to instruct the Inspector of Schools to impress upon school teachers, by circular and otherwise, the necessity for insisting on scholars attending their schools being treated and being free of the disease, and also the necessity for It is only by inducing the young generation using latrines to prevent the disease.

to appreciate the dangers of this disease, and the necessity for efficient sanitary measures, that we can hope to effect any final cure of it in this Colony. So far as possible, sanitary supervision will be maintained over the areas treated after the Commission passes on, but, unless the Government sanitary staff is considerably enlarged in the future, I can conceive of retrogression in those areas, especially in the maintenance and erection of privies. Castries and vicinity will be more easily controlled in this respect; it is the country districts which I have in mind in these remarks.

5. I am satisfied that Dr. Branch has made good progress in the campaign. during the past half-year.

His Excellency

SIB,

Sir G. B. Haddon-Smith, K.C.M.G., etc.,

Grenada.

Enclosure in No. 8.

I have, &c,

GIDEON MURRAY,

Administrator.

International Health Board Office,

Castries, St. Lucia, 15th January, 1917. I HAVE the honour to submit, for the information of His Excellency the Governor, the Director for the West Indies, and Your Honour, the following report, with tables and appendices, on the working of the hookworm eradication campaign in St. Lucia during the half-year ended 31st December, 1916.

The area of the campaign has been a direct continuation of that worked in the previous half-year. The period, from July, 1915, to December, 1916, makes a com- pleted geographical area, comprising the town and valley of Castries. It is separ- ated from the Cul de Sac Valley on the south by the ridge whose most important feature is Morne Fortune and Fort Charlotte; and on the east, from the Girard- Union Valley, by an encircling ridge whose dominating peak, Abercrombie Hill, still keeps green the memory of Sir Ralph and his Brigadier, Sir John Moore, in their military exploits in adding St. Lucia to the Caribbean group of British colonies. These three periods of six months each must be considered together as a whole, or in comparison only with one another.

Table 1 shows in detail the numbers dealt with during the period under review. The actual census has been smaller; the percentage of infection shows an expected The number who refused examination shows a marked and definite increase.

It would even have been less had I succeeded in overcoming the modesty decrease.

We have not yet gone far enough afield or other qualities of a household of eleven. to pass the migratory habits of the urban and more strictly suburban population.

Some of our friends and acquaintances whom we have pursued in previous Some have sub- half-year have again, and for the last time, passed under review. mitted to the inevitable and freed themselves of infection; some have again changed their abode; and we are left with a residue, with whom I am struggling to effect a It is this residue that has swelled the total remaining under treatment; a last chance is given to effect our ends rather than write them up as abandoning treatment.

cure.

I have made no changes in the personnel of the staff. Each nurse has himself worked one of the four sections into which I divided the area.

Table 3 is a convenient topographical distribution of the present area.

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Appendix B, a similar table of the completed whole, the Castries Valley and the letters A, B, C, D, E, F, marked in red ink on the map,* Appendix D), clearly shows how the completed area was divided up.

town

As the result of our technique in examining slides, it has been found that of an examined census of 2,662, with an infection of forty-seven per cent., with all the necessary subsequent examinations, only three instances have occurred in which we found an infection on the third centrifuge slide. I have decided, therefore, that it is not necessary to continue to examine more than two slides after centrifuging.

On a

When an area has been completed it is difficult to know how to carry on and finish up with the number remaining under treatment. This problem becomes more serious when the area completed is a geographical one, and the new campaign opens up in a district many miles away. With the prospect of moving out of the Castries Valley, I did not at first see what was to become of this remainder. visit to Antigua, on urgent family affairs, I had the opportunity of discussing the Four matter with Dr. Griswold. I found that he, too, had the same difficulty. nurses and two microscopists are fully employed at the start of an area, but as cures are effected the work of the microscopist gets less and the nurses are delayed waiting on the few to take their treatment and submit their containers. Dr. Griswold over- came the difficulty by employing several assistants as day workers in localities nearly finished by his regular nurses, who were thereby released to take up new work,

When I returned to St. Lucia, I tried for a month the same practice, and wrote the Director on the subject; before I could hear from him the question was solved by the Directorate at New York, who increased the staff of nurses from four to eight in the budget approved for 1917, making four nurses the complement to each microscopist, and allowing greater possibility of bringing a completed area to a final successful issue.

A more definite trial was made with oil of chenopodium, with liberal samples of capsules, containing ten minims and five minims, from Messrs. Parke, Davis & Company. A small area, known as the Darling Road, on the northern boundary of the town, was chosen. The examined census was ninety-two, of whom forty-one, or 44.6 per cent., were infected; one person left the locality before the treatment was started.

The dosage adopted was, for adults, i.e., from sixteen years and upwards, three capsules, ten minims each, one capsule every half an hour, followed by a dose of Epsom salts following the capsules. On the evening before the chenopodium was administered a dose of salts was given. The dose of salts following the capsules was graduated according to the effects that had already been produced.

In children of 9 to 15 years, three capsules of five minims each, and still one less for those that were younger.

I heard no complaints of the treatment other than an occasional heavy purga- tion. The activity of the oil of expelling round worms was often a source of gratifi- cation to the patient or parent.

Of the forty who took the first treatment, twenty-nine were registered as cured as the result of the treatment; seven were cured after two treatments; three required a third, and one is doubtful, not having yet taken the second treatment.

An examination at a later period of the cured lot resulted in twenty-seven maintaining their cures; from three we have not yet obtained this examination; of the remaining eight there have been curious variations, which I am inclined, in some cases at least, to attribute to reinfection; or a cure of adult worms in situ in the intestine may have taken place while embryo forms were still working their way to their permanent habitat. In every case of infection no re-examination was made

for at least seven days after a treatment. Unfortunately, this period was often prolonged to three or four weeks or longer.

A table of the working of forty cases forms Appendix C. During the period we have worked with two classes of thymol capsules. The older lot, purchased in 1915 from Messrs. Parke, Davis & Company, were filled with nearly equal parts of sugar of milk. Though rather bulky we considered them quite active and efficacious. The newer lot were purchased from the Apothe- caries' Society of London, and do not appear to have been triturated with any inert substance. My nurses have constantly asserted that with the new capsules they require to give more treatments. In November I lent Dr. Griswold, of Antigua,

* Not sent to the Colonial Office.

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