CO885-24 — Page 459

PUBLIC RECORD OFFICE

19

Reference :-

C.O. 885

24 PUBLIC RECORD OFFICE, LONDON

ALLY WITHOUT PERMISSION OF THE BE REPRODUCED PHOTOGRAPHIC- COPYRIGHT PHOTOGRAPH NOT TO

42

Explanatory notes accompany the statement (Appendix A).

17. On the 2nd July instant I received from the Governor an inquiry relative His Excellency has forwarded my to my willingness to continue my appointment. reply to the Secretary of State by a recent mail.

18. As the year of initial appointment of the Medical Officer in charge ter- minates on 25th August, it may be advisable for the Advisory Committee meanwhile to make recommendation for reappointment conditionally from that date, in order to maintain the continuity of the work, which will suffer by any uncertainty.

Report for the Month of August.

19. Operations have been continued at head office, in the Mount Moritz area, in St. David's, and in the last added area in St. Andrew's.

20. In the first week of the month there were two public holidays, and little work was accomplished in that week. The excessive rains of July, which affected the work, have persisted in August, causing many of the people to hesitate in continuing treatment.

21. Illness on account of malaria has kept one microscopist off duty from the 13th of August to 31st August Three other microscopists volunteered for Army service and had leave of absence on various days to enable them to answer formal obligations. One microscopist has been accepted for Army service, and his formal application for leave of absence is now presented.

22. The monthly summary of work performed in the areas under operation

is as follows:-

Location.

Patienta Patiota

Patients treater).

Total Patients

Original

NO..

⚫amine.

2

4. c. trentasenta.

cured.

infection

Headquarters

106

48

12

12

13

12 49

51

41%

Mount Moritz

350 243

76

78

81 119 354

74

St. David's

390 303

18

38

46

1,015 657

635 565

321 423 232 1,989 537

20

73% 62% 78%

1,861 1,251

741

693 677

684 2,795 145 70%

St. Andrew's

Total

23. In the Mount Moritz area all persons in the original census have been accounted for to date; several have not taken treatment for personal reasons, and some have died or left the district before being treated. Two hundred and thirty- These had all had three treatments eight have been struck off as "clinically cured."

or more and could not be induced to submit specimens for further re-examination. Four hundred and seventy-seven are still spasmodically sending specimens for re- examination and continuing treatment. Many of these will gradually be eliminated, treatment not being continued if re-examination is refused.

The figures for the area will be completed in the quarterly report.

24. In general the people will follow up three courses of treatment, but dis- taste for the medicine and for the collection of the necessary specimen for re-examina- tion becomes pronounced after. Morbidity is, on the whole, slight, and those who persevere with treatment beyond three or four courses are, in the main, those who showed anamic or dyspeptic symptoms. But, even amongst these, there are patients proceeding beyond nine courses of treatment who say they had no complaint of illness, and merely came to find if they were infected.

25. Of the recognized human hookworms, two have been found in Grenada— the Ankylostomum duodenale and the Necator americanus-of which the latter is by far the more common.

26. There has been no reason to suspect hitherto that there may be differences in the morbific effect of these two worms, or that the means of cure might affect one more than the other worm. In view, however, of the enormous differences in degree of illness that may be attributed to hookworm infection, the great mass of the popula- tion infected, who show trifling-if any of the usual evidences of the disease anky- lostomiasis, the few who undoubtedly show the disease, and further, in view of the fact that the number of worms or the length of treatment appears to bear no relation to the signs of disease, I have attempted to investigate the matter in relating the actual worm found to the degree of illness caused by the length of treatment required. 27. The ova alone cannot safely be relied on in making a differential diagnosis, and, in home treatment, it is found impossible to induce the patients to investigate the stools and bring worms for examination.

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There has been difficulty also in inducing patients to enter hospital, where they may be kept under observation, but at the present time certain patients have been secured to submit to treatment in hospital, and, through the courteous assistance of the hospital surgeon, I trust soon to ascertain definite information on the points detailed.

28. Up to within the last two months, for lack of any decided indication to adopt other methods, the safe conventional method of giving weekly courses of treat- ment has been followed. Recently, however, in many cases, the method has been adopted of issuing three courses of medicine at a time, with instruction to leave a day clear between the treatments, and to bring up a sample for re-examination on the fourth day after the last treatment.

The result is that a considerably higher proportion is found "cured" (that is, no ova are found) after three treatments by this method, and I have found no cause to indicate danger in forcing the treatment thus into five days instead of continuing the same treatment over three weeks.

29. Under the scheme of campaign, and with the large numbers under treat- ment, it is obvious that the same control cannot be exercised as may be within the power of the medical man in general practice; and it is with the utmost caution, under the conditions of this work, that any methods of treatment that might approach the "heroic " should be undertaken.

30. In the Parish of St. David's the number of re-examinations and treatments has fallen considerably, and at the end of September I propose to remove the general staff into St. Andrew's, leaving a small staff of assistants to pursue the work and continue treatment only to those who submit to re-examination.

31. The new area in St. Andrew's comprises the country from the St. David's boundary to the St. Andrew's River, with the sea on the east and the Etang Forest in the interior. It contains several large estates, with a small population, and scat- tered smallholders on the hills at Bamboo, Mama (de) Cannes, Munich, etc. Much of the population to be dealt with lives at an elevation of over 1,000 feet, and no more than two thousand people are found in this area, which is as large as an area of St. David's or the Mount Moritz area, which contained between three and four thousand of a population.

32.

This area is being dealt with by house-to-house visitation by assistants, and by location and domestic visitation by the Medical Officers. The nature of the country offers even more difficulties, owing to its remoteness from an habitable centre, than did the other districts already undertaken.

For that reason I propose that the field office and staff be removed to Grenville, which should form a suitable centre for dealing with this area and the rest of the Parish of St. Andrew's for perhaps the next nine months or more..

39.

Under this arrangement the Assistant Medical Officer would be stationed at Grenville with week-end visits to head office to assist in pathological and other investigations, and, while carrying on local work from headquarters, I should pay at least weekly visits to the St. Andrew's areas for purposes of supervision, lecturing, and general work.

34. Already I have made investigations of likely premises, and, on authoriza- tion, should carry out the removal after the end of September.

35. The rains, which have been practically continuous for the last two months or more, have demonstrated the capabilities of the pit closet properly constructed, and, at the same time, have afforded a valuable object lesson to householders who have been content with a mere makeshift hole in the ground.

36. In the areas over which the operations of the ankylostomiasis campaign have extended hundreds of smallholders have dug pits of varying dimensions as the first beginnings of a closet; but in comparatively few cases has any satisfactory structure been raised over the pits, and in still fewer have precautions been taken to prevent the entrance of storm-water.

37. In visiting their houses and in all lectures I have congratulated the people on the good start they have made, and warned them that whenever rainy weather set in they would find that their unprotected pits would be practically useless to retain excrement, and would be dangerous besides from mosquito breeding.

38. Now that the rains have verified these warnings it may be hoped that the little extra labour and expense will be forthcoming which are necessary to secure safety, and that soon there may be more examples of satisfactory closets from which the people may copy.