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PUBLIC RECORD OFFICE

Reference :--

mwimmimC.O. 885

24 PUBLIC RECORD OFFICE, LONDON

| ALLY WITHOUT PERMISSION OF THE

BE REPRODUCED PHOTOGRAPHIC- COPYRIGHT PHOTOGRAPH NOT TO

59537

No. 34.

JAMAICA.

THE GOVERNOR to THE SECRETARY OF STATE.

(Received 27th December, 1915.)

[Answered by No. 35.]

(No. 509.) SIR,

King's House, Jamaica, 11th December, 1915. I HAVE the honour to acknowledge the receipt of your despatch No. 294, of the 25th October last,* and, in reply, to transmit herewith a copy of the report by Dr. H. H. Howard, Inspecting Medical Officer of the Rockefeller International Health Commission, on his investigations of the incidence of hookworm disease and infection in Jamaica. Copies of the leaflet by the Central Board of Health and of the Superintending Medical Officer's circular referred to by Dr. Howard are also enclosed.

2. After consulting my Privy Council I was of opinion that the financial position of the Colony did not admit of the recommendations of the Commission being carried out at the present time. Dr. Howard was so informed, and I enclose a copy of the lettert which was addressed to him and of his acknowledg- mentt thereof.

3. I desire to take this opportunity of inviting reference to my despatch No. 299, dated the 29th July last, asking for particulars of the Fiji type of latrine which is recommended by the East Indian Indentured Labour Commissioners as uitable for Jamaica.

I have, &c.,

W. H. MANNING,

Governor.

Enclosure 1 in No. 34.

KEPORT BY DR. H. H. HOWARD, Inspecting Medical OffICER OF THE ROCKEFELLER INTERNATIONAL HEALTH COMMISSION, Washington, U.S.A., TO THE COLONIAL SECRetary, Kingston, Jamaica,

SIB,

The Rockefeller Foundation International Health Commission,

725, Southern Buildings, Washington, D.C., 8th February, 1915. THROUGH the courtesy of your Government and the kindness of Dr. J. E. Ker, I was permitted to visit various districts in Jamaica and observe the clinical evidences of the presence of ankylostomiasis among the several elements of your population and sanitary conditions as they apply to this particular disease. Further, I was given opportunity to go over reports of District Medical Officers and reports from public institutions, including the general hospitals and patho- logical laboratory, where systematic examinations are being made, as recommended by the Supervising Medical Officer, to ascertain the occurrence of ankylostome infection in the various medical districts of the Colony.

Summing up the information thus obtained, I beg to submit the following

conclusions:—

(1) Ankylostomiasis is prevalent throughout the island of Jamaica, the intensity of the infection varying with the rainfall, local conditions, and the race dealt with, but quite severe in all instances; the laboratory reports indicating from 66 to 98 per cent. infection.

(2) The severe types of the disease are quite common, deaths having been reported from several districts many more probably occurring among those who do not seek medical aid, and are hence unrecognized.

(8) At the present in rural sections fæcal contamination of the soil is univer- sal, as it was in the Southern States and in many of the West Indian Colonies already visited.

* 42152: not printed.

+ Not printed.

87669: not printed.

Soil pollution in Jamaica seems to be due to several factors

(a) Lack of knowledge on the part of many of the people as to the dangers

of soil pollution.

Lack of latrines of proper type conveniently located.

Lack of proper supervision and inspection of existing latrines.

(d) In many instances lack of latrines of any type.

It has already been noted, from time to time, by the Supervising Medical Officer and others of the medical profession of Jamaica, that the prevalence of ankylostomiasis among the labouring classes causes an enormous economic loss each year, besides very materially increasing the occurrence and death-rate of other diseases.

While the steps already taken to thymolize newly arrived coolies-among whom the infection is always high-and to give thymol to others who are found infected when admitted to the hospitals for other diseases, are admirable and in the right direction, yet it must be evident, because of the large population of the island and the comparative severity of the infection, that more radical and com- prehensive efforts must be made if the disease is to be controlled and ultimately eradicated.

*

While the steps necessary for the prevention of ankylostomiasis are well stated in the leaflet issued by the Central Board of Health, 12th January [February], 1913, and further emphasized by Circular No. 1581 (Dr. J. E. Ker), only by the rigid enforcement of these recommendations can we hope to successfully combat the disease.

In the consideration of the problem of eradicating ankylostomiasis we have to deal with:-

I-Remedial agencies, i.e., curing those who have the disease. II.-Prophylaxis, which resolves itself into the prevention of fæcal pollution

of the soil.

I.—Remedial Agencies.

The points upon which any campaign of eradication and its results must be judged are:

(a) Thoroughness of the work done from a scientific standpoint.

(b) Per cent. of population examined and per cent. of infected treated to

a cure, i.e., the degree of eradication obtained.

(c) The per capita cost of the campaign.

Manifestly any undertaking of this nature loses value as a demonstration as

the per capita cost increases to that point where it prohibits operation in extensive

areas.

Our experience with this problem, in the past, both in the United States and West Indian Colonies, has led us to conclude that the most satisfactory method of dealing with ankylostomiasis when eradication is the end in view is that in each campaign we should :-

(1) Operate in a definite area.

(2) Make a careful enumeration of the entire population, placing in

record book of proper form such data as is essential.

Examine every individual in the area microscopically.

Treat all found infected to a cure.

Re-examine all under treatment at intervals, not discharging any from treatment until cured.

To accomplish this a field laboratory is established in a convenient location

in the area, where microscopical examinations are made, treatments issued, and from It has been which the campaign is directed by the Medical Officer in charge. customary to require the subordinates of the force in each area to move to and reside near this laboratory.

After an area is thoroughly covered and re-examinations show all infected cases cured, the second area-preferably adjoining territory-is selected and the same course pursued with it.

II.-Prophylaxis.

While sanitary conditions within the areas where eradication is attempted are manifestly matters with which the Government and local sanitary authorities must deal, yet their important bearing on the success of the undertaking leads me to Buggest the "three essentials" from the International Health Commission's viewpoint.

* See pages 58 to 56 of Miscellaneous No. 297.

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