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population and cultivation, so long as these are free from Glossiņa palpalis. It will, on the contrary, generally be advantageous to be near such centres, on account of the facilities they offer for obtaining a plentiful supply of food and other necessaries for the sick people.
Note (I.). See Maps I., IV., and V. Note (II). See Map IV.
I have, &c.,
AUBREY D. P. HODGES,
Médical Officer in Charge, Sleeping Sickness Extended Investigations.
Note (III.). November 18, 1906. Nine hospital assistants would be much better and more useful if they can be obtained. I calculate, with reference to European staff, that two European Medical Officers should, if possible, be retained for the present on travelling investigation to complete the enquiries which are being made, or until this class of enquiry is completed.
(No. 81/S.S.E.)
(Enclosure 2 in Appendix F.)
Entebbe, October 25, 1906.
SIR,
I HAVE the honour to inform you that, His Excellency the Commissioner of the Uganda Protectorate having taken up the scheme of segregation of the sick for the prevention of the spread of sleeping sickness, it seems to me that the same arrangements which will be required for applying this may be most advantageously used for an extensive trial of the atoxyl treatment, of the success of which there have been reports both from Europe and from the German Sleeping Sickness Com- mission.
I have therefore sent to His Excellency a proposal, a copy of which is enclosed (No. 78/S.S.E. of October 20th/06), for these two measures to be carried out conjointly.
You will see that a considerable increase of the staff of the Sleeping Sickness Extended Investigation will be needed for the segregation camps, but I do not think that the use of the atoxyl treatment will, apart from the segregation scheme, lead to any serious expense beyond that for the purchase of the drug and a few necessary appliances.
You will see also that a large quantity of atoxyl will be required, since the patients at each camp will probably number thousands, and I consider it most important to obtain a good supply immediately, so that the two measures can be combined as nearly as possible from the start, and that they may be begun while the natives are still in the enthusiastic humour in which they appear to be now of presenting themselves eagerly for this treatment.
AUBREY D. P. HODGES,
*
I have, &c.,
Medical Officer in Charge, Sleeping Sickness Extended Investigations.
To the Principal Medical Officer.
APPENDIX G.
INSTRUCTIONS TO MEDICAL OFFICERS ENGAGED IN THE EXTENDED SLEEPING SICKNESS
INVESTIGATIONS.
February 20, 1906.
The initial steps to be taken in this investigation will be the minute study of the distribution and habits of Glossina palpalis and of the areas which have become, or are likely to become, infected with sleeping sickness.
By these studies, carefully carried out, an exact knowledge should be gained as to the co-existence or otherwise of the disease with this particular fly and, there- with, sufficient data to determine the possibility of the existence of other means of
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dissemination. Valuable information should also be acquired as to the probable directions in which the epidemic may in future spread, as to the likelihood of small or large outbreaks occurring in different localities and as to what, if any, general hygienic or administrative measures would be likely to be successful in preventing its extension.
Special attention should be given to the feasibility of local segregation of the sick from fly-infested villages or circumscribed fly-areas by the natives themselves, since there is reason to hope that in many cases this could be done through the local chiefs with little trouble or expense and without incurring the opposition, sentimental or otherwise, of the natives.
By the use of tact in the inspection and examination of natives and by giving them medical treatment for their ordinary ailments their confidence should be so far gained that later on systematic blood and gland examinations and special systems of treatment for sleeping sickness may be carried out among them with much greater chance of completeness and experimental success than could be hoped for at present.
The following paragraphs explain in detail what is included in the measures indicated above and contain information relating to methods of investigation, &c.
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It is
1. The term fly-belt has as yet no exact meaning and should not therefore be used in descriptions or on maps. Glossina palpalis is known to frequent localities near the water where there is shade. It is probable that there must be some, how- ever little, open water in these localities and some conformation, such as rocks, shelving beach, cliffs or high banks, which ensures a moderate dryness for a great part of the year, and it would seem that wide belts of swamp-vegetation, such as papyrus, behind which is no open water, though often plenty of shade, are inimical to its presence. All these last points require confirmation. The localities infested by the fly, called herein fly-areas, vary much in extent. They may be quite small, circumscribed and isolated, or many such areas may form more or less continuous chains for considerable distances along the borders of lakes or rivers. important that the limits of these areas or groups of areas should be accurately ascertained before any general measures such as local segregation can be carried out. Also, the fly is known to follow water-carriers and others for some hundreds of yards. It is necessary to determine how far from their usual haunts flies will travel in this way, how far they may wander under other circumstances and, Thus especially, how far from water their haunts or areas may be situated. specimens for identification should always be obtained and sent in in case tsetse are met with at any considerable distance from water, since some species, notably G. morsitans, are frequently so found, and it is probable that in many instances in which the presence of tsetse has been reported at a distance from water the species was some other than palpalis. During recent investigations in Unyoro and the Nile Province the fly-areas were always found to be close to water and circumscribed. On approaching such an area a fly was seldom seen much more than 50 yards from the water though on leaving it they were sometimes observed to follow for a distance which never exceeded 200 yards. Tsetses which were caught at a greater distance from water than this were invariably G. morsitans.
2. The fly-areas, then, should be carefully mapped out and the physical conditions prevailing in each as regards shade, rocks, cliffs, distance from open water, stream, swamp. &c., should be noted, compared and tabulated for report; and the fly-range, or distance which it may wander from its actual haunts, should be determined.
3.
In its With the appearance of G. palpalis medical officers are familiar. flight and manner of settling it resembles other tsetse flies. The former is rapid and direct and it settles abruptly, as a pellet of mud sticks when thrown against a wall, yet so gently that it is scarcely felt. There is no hovering and little or no movement from the point of settling before it bites or is driven off. Its buzz is a continuous note broken only when it alights.
4. All the habits of the fly should be carefully observed, its numbers in the various fly-areas and its local distribution, especially as regards the proportion of males to females. In localities in which this proportion has been studied the males have been found to preponderate largely, and this fact may be connected with its breeding-habits. Whenever wandering or following flies such as have been alluded to above are taken the sex should always be determined.
5. The hours of the day during which G. palpalis is active are not yet
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