་་ས་པ་་་་
C.O.885
18
PUBLIC RECORD OFFICE, LONDON
ALLY WITHOUT PERMISSION OF THE BE REPRODUCED PHOTOGRAPHIC-|
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cedented wave of sickness, consisting chiefly of malaria and dengue fever, passed over the country, and prevented any opportunity of personally inspecting, as I had hoped to do, the investigations of the Medical Officers, but I am glad to record that the general satisfactory nature of their reports precludes any regret on that score.
The period under review, then, in this report is roughly six months, from the commencement of operations till August 31st..
My main object has been to obtain in the first place an accurate knowledge of the distribution and habits of Glossina palpalis, and, whilst doing this, to gain the confidence of the natives, so as to be able the more easily and profitably to apply later on these preventive measures which might appear advisable, and any form of treatment which might in the meantime or in the future be discovered.
The result is so far satisfactory that a sufficient working knowledge of the distribution of the fly for practical purposes has already been obtained, and though, as regards its habits, there are still important details to be learned, I believe that in future its distribution will need investigating only in special places and for special purposes. I think I may also say, judging from the general reception of the Medical Officers, the increased interest shown in their proceedings, and the notice taken, in many places, of their recommendations, that the confidence of the natives in our motives and methods has been so far increased as to render the application of any general measures much more likely to be successful, in many parts of the Protectorate, than has been the case in the past, when the general attitude has been one of suspicion and passive resistance, or, at the best, indifference. In framing my general instructions to the Medical Officers the two measures most in my mind were segregation of the sick and clearing of the jungle in those haunts of the fly near to human dwellings and on traffic routes, and I was anxious to follow up, and, if possible, confirm the observations which I had made in Unyoro and the Nile Province, and which have already been reported to you (Note 1.),* especially those which seemed to me to afford a hope that in some form or other either or both of these measures might prove capable of successful application.
I consider that we now possess sufficient knowledge of the distribution of sleeping sickness and of the fly to enable us to say with certainty what places it is most important to clear, and to judge with a fair amount of accuracy to what extent the clearing should with advantage be carried, while we can also decide definitely from what localities the sick should be removed and to what localities they can be removed with absolute safety to the community as regards infection.
Hitherto the results of clearing as it affects the fly have not been well under- stood, nor has it seemed to be realised to what extent and in what localities it was most urgent. And, in particular, confusion of ideas has existed as to what con- stitutes an "infected locality," so that it will be well at once to state definitely what the term might be supposed to include, and also what is meant by it in this report.
An infected locality as regards the fly is a fly-range or series of fly-ranges which, directly or indirectly, by settlement or communication, is in contact with a place or places in which there is sleeping sickness, and it will remain infected so long as it is in contact with such places, and, if contact be cut off, so long as infection endures in the fly, which is at present an unknown quantity. It is, therefore, a circumscribed area consisting of a narrow strip from a few yards to a few miles in length along a lake-shore or river bank, in which area the disease is communicable to man, and in which the duration of infection, after all infected vertebrates have been removed, is at present unknown.
An infected locality, as regards human beings, on the other hand, may be of very much wider extent, and in it the disease is not catching except where it coincides or comes in contact with the fly-ranges (which form, as a rule, a very small proportion of it). I think, therefore, that it would be better, for the sake of clear- ness, to use the term "infective " to describe the former locality and to retain the term
infected" for the latter only.
It is these "infective localities" which need to be destroyed, wherever practic- able, by clearing; and it is from these localities and from communication with them, where their destruction by clearing or otherwise is not practicable, that it is necessary to remove the sick.
•
Segregation has been more than once brought forward as a general measure,
• NOTE I.-Report on investigations in Unyoro and Nile Province, November, 1904-February, 1905
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but rather in the form of a prolonged quarantine, and, owing to the uncertainty felt with regard to finding safe locations for those who were to be segregated, and also as to the exact localities from which all the sick should be removed-owing, in fact, to the impossibility of forming any clear idea as to the necessary extent of the under- taking the plan has been abandoned.
hope to be able to show, in the course of this report, that neither of the above measures, extensive though they both may be, is of nearly so vast a magnitude as has been feared, and that, whatever difficulties may stand in the way, their appli- cation in some form or another should, if any effort at all is to be made, be begun without further loss of time and while there yet remains the possibility of saving
many lives.
With regard to sleeping sickness and its distribution little has been added to our former knowledge, and, except for a gradual extension northwards in the Nile Province, which may be an extension only as regards our knowledge of its existence there (see below), it remains practically in statu quo. On the whole the reports seem to show that cases are considerably less numerous than formerly, probably on account of the large proportion of the inhabitants of the worst localities who have already died, and of the fact that many of the survivors from these places have fled inland. The disease has been everywhere found to be most closely associated with the fly, and apparently there has been no difficulty in deciding that all cases found at a distance from the haunts of Glossina palpalis are "imported" ones.
On my way from Gondokoro in December last to assume charge of these investi- gations I found sleeping sickness to be epidemic at two places on the Nile bank midway between Nimule and Wadelai. At both these places fly was present, and at neither was there a customary camping-ground for travellers. It was evidently not a very recent introduction, and the Medical Officer who has since investigated there reports it to be of at least four years standing in that region. In my report already referred to (Note I.) I recorded the fact that Glossina palpalis was present on most of the inland streams north of the Victoria Nile, and probably on all, This wherever the conditions of open water, shade, &c., were favourable to it. particular part, however, I was unable to examine, except at the two places at which the steam-faunch touched, which carried me from Wadelai to Nimule. It is, in fact, a part seldom traversed on land by officials, and then always as rapidly as possible, owing to the great difficulty in obtaining porters; and that appears to be the reason why the disease failed to come under notice earlier. Moreover, there, contrary to what obtains at most other places, the fly, and therefore sleeping sickness also, is much more plentiful on the inland streains than on the Nile itself, on which, indeed, it is rarely found in this part of its course, at least on the Uganda side. Inter-tribal communication is free, both inland and across the Nile, on both sides of which the disease exists, and, though the population far from numerous and the villages are scattered, I fear there is little hope but that the infection will eventually spread as far as the northern limit of the fly, which is, on the right bank, some 40 to 50 miles south of Gondokoro. There is, however, little chance of an epidemic of the magnitude of that on the Victoria Nyanza.
A small and circumscribed epidemic was found by Dr. Wiggins to exist between Usoga and Mount Elgon, and will be referred to later. The genuineness of the epidemic reported to exist some time ago on Lake Albert Edward is open to serious doubt, as will be seen below. It is probable that it may turn out to be beri-beri or, perhaps, both this and sleeping sickness may be present, since the fly, at any rate, is plentiful there. Unfortunately it has been impossible hitherto to investigate it thoroughly, owing to political reasons.
I did not anticipate that the Medical Officers, who have been constantly travel- ling would be able to do very much in the way of microscopic investigation and experiment, but accounts of some ingenious and interesting experiments by Dr. Bagshawe on the flight of Glossina palpalis along river banks are appended and also a report by Dr. Van Someren on the presence of Trypanosoma gambiense (?) in naturally infected native dogs.
Incidentally I have caused enquiries to be made into the existence in the Uganda Protectorate of the fly Auchmeromyia and its larvae, the Congo or floor maggot, and it seems likely that Auchmeromyia luteola and possibly other species will be found to be widely distributed, but the identification of specimens is not yet complete.*
⚫ Report since received from Professor Austen, British Museum. The fiy or maggot of A. luteola has been collected in Uganda, Usoga, Unyoro, and the Nile Province.