Mass Treatment for Hookworm Infection on Tea Estates in Assam

The tea estates under consideration are located in the Sylhet District which is situated in the south-western portion of the Province of Assam, bordering on Eastern B.engal. These tea estates are in an area about twenty-five miles longand about fifteen miles wide, all being on fairly high ground which is intersected by rice paddy fields. The rainfall in the district averages about one hundred and ten inches per annum and is distributed fairly evenly through the months of May to October inclusive, except for an occasional heavy rain just before this period and a few very light showers during the cold weather months. The mass treatments were therefore given between the 1st February and the 6t'h April, this being the driest time of the year and there being smaller chances of t'he coolies becoming re-infected then. The coolies on these tea estates have been recruited from Madras, the Central Provinces, United Provinces and a few from Bihar and Orissa. About 80 per cent, of the labourers employed are old coolies who have been employed on the estates for years, the remainder being coolies who have been recruited year by year and who usually arrive from their various countries infected with hookworm. This being the case, new coolies are a constant source of infection and they should all be treated immediately upon their arrival upon an estate. No labour is locally recruited but villagers do, on occasions, come into the various estates to work by the day, but they do not live in the lines and are therefore not to be considered from the standpoint of infecting labour in estate lines. Coolie houses are usually built in streets where the available land will allow, but in many instances they are very badly scattered due to the hilly formation of the land in t'he Sylhet District. In some instances the lines are surrounded by jungle, but usually there is tea or rice paddy land on one or more sides. Few tea estates have any definite latrines except those which are required by the Factory Act, and coolies generally pick out defaecation areas in the neighbourhood of their houses, the majority seeking nearby jungle, tea or other screening, while others are not so particular and defaecate in the open in the immediate area around their houses or in open rice paddy land. The general habit is to stick to the one localized area and these defaecation areas become constant sources of direct re-infection as well as feeding places for pigs, dogs and cattle, who, in turn, deposit their hookworm-laden faeces in the lines where infection of the coolies may again take place. Ramsey (Indian Med. Gaz., Sept., 1923) says: " The reason the pig is so dangerous in spreading hookworm is that having gorged himself with human faeces from the jungle around the lines, he returns with his faecal-laden bowel to disseminate his helminthic iand protozoal infections around the coolie huts. " This certainly applies to dogs as well and may even apply to cattle. Coolie houses are usually built of bamboo with thatch roofs, the bamboo walls being plastered with clay mixed with fresh cattle manure. The women do t'his work and this may account for the relatively Tabu} I.