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Enclosure in No. 5.
ACTING PRINCIPAL MEDICAL OFFICER, Northern Nigeria, to the SECRETARY.
October 19, 1906.
I have received a detailed report of two cases of sleeping sickness under the care of the Medical Officer, Akwatcha. They were isolated at that station by my instructions. Both cases are men of the 2nd Northern Nigeria Regiment, and it has been suggested that they should either be discharged or sent to Lokoja.
2. If they are discharged a difficulty arises as to their maintenance.
3. They cannot be sent to Lokoja for fear of bringing the infection there. The only fly known, at present, to convey the infection of sleeping sickness has been identified on the Niger near Lokoja. For obvious reasons they cannot be set at large in the vicinity of Akwatcha, and, in addition to these considerations, it is of vital importance in the interests, not only of science and preventive medicine alone, but in the interests of the public service, that they should be kept under olservation and reported on.
4. The report states that last April a soldier's wife was driven out of barracks because she was suffering from sleeping sickness. This fact has only recently come to light. It was not reported at the time to either the Medical Officer or Officer Commanding. The two men appear to have [been] taken ill, one in the following June, and the other in August. This would point to the likelihood of their having been infected from her, and, consequently, if the supposition is correct, to the existence of a fly capable of transmitting the infection.
5. The barracks and fort at Akwatcha are described as being built on a cleared space which is practically surrounded on all sides by narrow belts of dense forest, through which run small streams of water, and which abound with tsetse flics. So far the Glossina palpalis has not been identified. At the eastern side of the fort the forest is only about 200 yards distant, towards the west 400 to 500.
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The hospital is only separated from the barracks by the parade ground, there- fore the isolation afforded by it is hardly sufficient to protect the troops. Medical Officer states that it could not be further removed and occupied.
6. I would strongly recommend that Akwatcha should be abandoned for a suitable site in a non-tsetse district, or one where there will be a possibility of safe- guarding the occupants.
W. H. LANGLEY, Acting Principal Medical Officer.
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No. 6.
UGANDA.
MEMORANDUM ON THE PROPOSALS CONTAINED IN THE COMMIS- SIONER'S DESPATCH, No. 218, to THE SECRETARY OF STATE.*
(Received January 24, 1907.)
1. The scheme, as outlined, is, in my opinion, not practicable, and presuming that it were so, there is great doubt as to whether it would have the effect of stamping out sleeping sickness in Uganda.
2. It will be extremely difficult, if not impossible, to ensure that every infected person should be segregated, and as it is proposed to retain places like Entebbe and Jinja within the fly zone, as inhabited centres, these will remain as foci of infection, from which the disease may again spread in epidemic form if, later on, the tly area is re-occupied.
3. A very small limited area round the European quarter in Entebbe may have been absolutely cleared of fly (personally, I doubt it), but it must be remembered that the station is situated on a peninsula, and the only land approach to it passes through some miles of forest full of tsetse fly. The town is dependent for its exist- ence upon a native population, and it is out of the question to imagine that it will be possible to stamp out the fly throughout the whole surrounding district in which the natives live.
No. 100 in Miscellaneous No. 178.
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4. Some months ago I was asked to give my views in regard to the question of abandoning Entebbe. I pointed out then that the only logical course was to vacate the whole fly area. 1o do this it would be necessary to give up Entebbe, and as this involved a very heavy pecuniary loss, I stated that it might be advisable for His Majesty's Government, before taking such an extreme measure, to expend some money on experiments in regard to methods of treatment, for hitherto this side of the question had been very neglected. Such an expenditure would be justifiable, and might lead to important results, but segregation will lead to nothing, except in so far that it is proposed that experiments and treatment should be carried on in these concentration camps.
5. Such places are, however, not eminently suited for accurate investigations, and there will be great risk of this aspect of the question being neglected in favour of what is regarded as the primary object, namely, segregation. In any case the expenses connected with the latter must necessarily be very great, and will certainly monopolize the larger part of the money and energy available.
6. To carry on experiments and treatment all that is required is-
(a) A constant and regular supply of patients, not too many, under complete
control.
(b) Adequate means and unrestricted facilities.
7. In regard to sleeping sickness in Uganda we may consider the mischief as done. The disease has become endemic, and we shall not stamp it out until we find either a cure, or a means of exterminating the fly. Neither of these is known to us so far.
8. If the disease had been just recently introduced, it might be worth while to attempt its eradication by methods of segregation, but in a place where it is so widespread, such measures are not likely to avail, especially if regard be given to the fact that there may be other animals which harbour the trypanasome, and
if such exist the evacuation of the fly area would be useless.
9. I myself recognize three main lines of research:-
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(a) The purely scientific. This can be done much better in Europe. Animals can be infected with trypanosomes with great ease, and scientific investigations in regard to pathology and treatment can, and should. be unceasingly carried on under the favourable conditions afforded by well-equipped laboratories.
(b) Practical experiments in treatment and prevention. These, of course, can only be conducted on the spot in endemic areas, but money should not be squandered upon methods which are in conflict with proved theories and known facts.
(c) Experiments in regard to the means for preventing the disease from spread- ing into entirely new areas. In this connection the continental distri- bution of the fly is of the utmost importance. All the nations interested in Africa should work out the distribution of the fly in their territories, more especially near the boundaries between one sphere of influence and another. In a given area like Uganda, where the disease is endemic, the local distribution of the fly is of minor importance. It is necessary to look further afield to the adjoining countries as yet unaffected. In fly areas careful watch should be kept for the first sign of the disease, and when it appears, the people should be made to migrate. It would be better indeed even now to discourage the natives from inhabiting all places known to harbour fly.
R. N. MOFFAT.
No. 7.
NORTHERN NIGERIA.
COLONIAL OFFICE to SIR P. MANSON AND THE ROYAL SOCIETY.
Downing Street, January 25, 1907. WITH reference to the letter from this Department of the 16th November
GENTLEMEN,
SIR,