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67-82 per cent.

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14 1

82

61

them to such degree that they would leave the estate. This has been one of the diffi- culties in the way of systematic effort for the control of this disease in that Colony.

Dr. Snodgrass also states that the officials and plantation owners are showing the greatest interest in the work and are giving every possible co-operation. He is delighted with his reception, with the co-operation which he is receiving, with the progress of the work, and with the outlook for its future.

This first report of the work is especially interesting, because of the fact that we regard Ceylon as a point of very great strategic importance. We hope that the work which we are doing there may prove an entering wedge to a much larger work in India. The result of the work in Ceylon will be felt also in countries farther east.

Very sincerely yours,

WICKLIFFE ROSE.

The Honourable

Walter H. Page,

American Embassy,

London.

Natives:

APPENDIX C.

Locality and Degree of Infection.

Locality

Number examined. Number infected.

Castries

33

26

Anse-la-Raye

1

1

Canaries

1

1

Soufriere

18

12

*

Choiseul

3

3

Laborie

11

6

Vieuxfort >

8

4

Micoud

2

1

Dennery

20

18

Gros Islet

9

4

Residents from other islands

18

6

Total

122

82

13524

No. 37.

CEYLON.

INTERNATIONAL HEALTH COMMISSION to THE UNITED STATES AMBASSADOR, LONDON.

(Received in Colonial Office, 20th March, 1916.)

[Copy to Governor, 30th March, 1916. No. 183. L.F.] The Rockefeller Foundation International Health Commission,

61, Broadway, New York, 2nd March, 1916.

DEAR MB. PAGE,

We have just received a lengthy letter from Dr. Snodgrass, whom we sent to Ceylon to inaugurate work for the relief and control of hookworm disease in that Colony. This letter shows that work is now under way on three rubber plantations in the Matale District. This is one of the districts which I inspected at the time of visit to Ceylon, and in which I found what I regarded as a heavy infection,

my though the infection did not appear to be as severe as on the estates about Ratnapura. Dr. Snodgrass states that they have examined microscopically 1,350 persons, and that so far the infection is running about 98 per cent. The coolies are responding readily both to examination and treatment. This is especially gratifying in view of the fact that the plantation owners had maintained that it would be extremely difficult to examine and treat the coolies, and that on effort to do this probably would disturb

(No. 7106.)

Enclosure in No. 37.

16th February, 1916.

MEMORANDUM

ON THE USE OF OIL OF CHENOPODIUM FOR THE TREATMENT OF UNCINARIASIS, Being an extract from a personal letter written by Dr. Schuffner of Sumatra, 28th November, 1915, to Dr. Victor G. Haiser, Director for the East of the Rockefeller Foundation International Health Commission.

THE following is an extract from a personal letter to Dr. Heiser from Dr. Schuffner of Sumatra, written 26th November, 1915, with regard to the use of chenopodium in the treatment of hookworm disease:-

We found by systematic You ask as to the dose of oil of chenopodium. experiments that 1 gramme per treatment is the maximum amount which should be used. If a smaller dose is used the number of worms expelled becomes consider- A local physician ably less; if.a larger dose is used the number is not increased.

uses as much as 18 grammes of oil of chenopodium. I believe this large dose is unnecessary, but I mention it in order to show that even with this higher dose he states that no unpleasant symptoms are observed, nor are there evidences of intoxi- cation. It is, of course, necessary to take into consideration the weight of the patient. Our coolies seldom weigh more than 120 pounds, and very often less. This dose is some- For years we have been using a dose of 1-2 grammes per treatment.

Because what higher than we have proved experimentally to be the minimum dose. of their greater weight I give Europeans 15 grammes. I should assume that this would probably be the correct dose for the types of persons whom you treat in the United States. From my personal experience I know this dose is absolutely safe; that no unpleasant effects are experienced; and that the hookworms are effectively expelled.

cause uncomfortable "I myself have suffered enough from uncinariasis to symptoms. I had no confidence in thymol, because it seemed impossible to rid myself completely of the hookworms even after repeated treatment. I was most agreeably surprised to find, after the chenopodium treatment which I took last May, that my my stool was free from hookworm eggs and has remained free up to the present time. have been making regular weekly examinations in order to test the permanency of the cure.

The experience in my case was all the more reassuring because the number of worms found at the washings which I made was small, and by no means corresponded to the quantity of eggs in the stools.

In view of the foregoing, it is evident that the after effects of the treatment should not be under-estimated, and that one should not judge the efficacy of the treat- ment entirely by the number of hookworms found at the first washing. It is questionable whether such a satisfactory result could be expected in heavily infected persons. I have had a number of very ill patients who suffered from oedema, for whom five or six treatments were necessary in order to expel the presumably

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