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endemic areas are found. Dutton and Todd have shown that the rapidity with which sleeping sickness spreads is in direct relation to the ease with which communi- cation with different parts of the country is maintained. The disease spreads only very slowly from an infected centre, but is carried very rapidly. If in view of this the natives of North-Eastern Rhodesia are allowed to go to work in the Katanga mines, it is certain that Rhodesia will be infected in a comparatively short time. Dr. Spillane's estimate that the disease will not reach the Luapula River for two or three years is probably too long. In the report sent by Dr. Noble on the results of his investigations along the border between North-Eastern Rhodesia and the Congo Free State he mentions that there was one imported case at Kasenga, on the Luapula. Tsetse flies, both palpalis and morsitans, are found along its banks (certainly on the Congo side, and probably on the British as well).
It has never been claimed that the institution of quarantine measures and the regulation of native movements will absolutely prevent sleeping sickness from spreading, but it is anticipated that they will delay very markedly such a spread, and thus give time for the institution of other measures, such as treatment, which will tend to combat the disease. For cases of sleeping sickness to occur, it is not necessary that tsetse flies should be present in large numbers It was found in the Congo, for instance, that the disease was endemic in regions where very few flies could be found,
For these reasons we are absolutely opposed to the decision to allow natives to be recruited in Rhodesia for the Katanga mines. The question is most grave, and demands the most careful consideration of the authorities. Should the disease obtain a foothold in Rhodesia there is every prospect of a repetition of the experi- ence of the Congo, Uganda, and Portuguese West Africa, the people decimated, and the development of the country delayed for many years to come. The matter is so serious, and the danger so threatening, that no commercial considerations whatso- ever should be allowed to influence the regulation of the movements of the natives. The distribution of tsetse flies in Rhodesia has not been satisfactorily deter- mined. In Portuguese West Africa Glossina palpalis has been found as far south as 14°, and in the Congo Free State right to the Rhodesian borders. In Rhodesia and British Central Africa its presence has not been definitely reported, but it will doubtless be found. They may be very scanty, but before any region can be said to be free of them, a most careful and lengthy search is necessary. Glossina morsi- tans is found in both Rhodesias. The statement that Glossina palpalis is not found above an altitude of 2,000 feet, also requires to be qualified. In the Congo it was found by Lieutenant Brohey as high as 4,000 feet above sea-level. The question of definite fly-belts for Glossina palpalis is in rather a confused condition. They were never observed in the Congo. In British Central Africa "the theory of defined and permanent tsetse 'belts' is incorrect" (Report, British Central Africa Protectorate, 1905-6). Mr. F. W. Arnott, of the Garenganza Mission, told Dr. Todd and me that he had never come across them. The number of flies may vary very greatly, and they may be present in enormous quantities in certain districts, but caution must be observed in accepting the dictum that the flies are restricted to well- defined unvarying belts, and thus that the danger of sleeping sickness occurring only exists in such districts: In all probability it is just a question of degree.
It is not at all settled that Glossina palpalis is the only carrier of the infection. The evidence, so far as is yet known, goes to show that the transmission is merely mechanical. If this be true, we must ask ourselves whether other biting flies cannot transmit Trypanosoma gambiense. Cattle trypanosomes, usually spread by means of Glossing morsitans, have been transmitted to non-infected animals by Glossina palpalis (Greig and Gray), tabanida (Sergent), Glossina pallidipes and fusca (Koch), and stomorys (Minchin, Tulloch, and Gray). If we may argue by analogy Trypano- soma gambiense may be spread by insects other than Glossina palpalis. This perhaps does not follow. but until decisive results are obtained, it only emphasises the necessity for regarding with suspicion all species of tsetse flies, and possibly other biting insects as well.
Every effort should be made to teach the native chiefs the relation which exists between tsetse flies and sleeping sickness. They should be taught that enlarged cervical glands mean sleeping sickness. and that any of their tribe who suffer from them should be sent to the nearest medical officer at once. They should be urged to remove their villages from the immediate neighbourhood of streams, and also to clear the underbush for a distance of at least three hundred yards around
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the villages. Such ground can be cultivated with a low-lying crop, such as ground nuts. It should not be a difficult matter to persuade them to take these steps, as in many districts in the Congo they have so moved their villages.
All
At this distance it is impossible to say anything about the methods to be adopted in instituting quarantine posts. If feasible, it would be a very good plan, as sug- gested by Dr. Collier, to restrict the ports of entry into the different districts. natives travelling from North-Eastern Rhodesia to North-Western Rhodesia, and vice versa, should be examined at some point along their route, and all doubtful ones turned back. In the event of sleeping sickness being found, the cases should be isolated in a hospital or camp in infected territory, or failing this, at some place where tsetse flies are not found. The treatment should consist of injections of atoxyl, as advised by Thomas and Breinl (Liverpool School of Tropical Medicine, Memoir XVI.), and is best carried out as given by Breinl and Todd (British Medical Journal, January 19th, 1907). While atoxyl has a very decided and beneficial effect, it cannot be regarded as an absolute specific. The data are too meagre, and the treatment has been in use too short a time for any definite conclusions to be reached. In connection with the treatment with atoxyl, it is now advised that injections of mercuric chloride should also be given. In a preliminary note pub- lished in the Annals of Tropical Medicine and Parasitology, Volume I., No. 1. Moore. Hierenstein, and Todd state that the successive employment of these two drugs is followed by better results, in animals infected with T. Brucei, than the use of atoxyl alone. The atoxyl should be given until, and for a week after, the try- panosomes disappear from the blood and gland juice, and should then be superseded by the injection of mercuric chloride (British Pharmacopoeia preparation used). This plan of treatment promises better results than have hitherto been obtained, and should be tried in cases of human trypanosomiasis. Accurate case records should, of course, be kept. One of the most important measures to be adopted is that of making all employers of labour, in whatever capacity, personally responsible for the natives under their control. It should be a legal offence, punishable by heavy fines, to have a native with enlarged glands in one's service, unless, of course, it can be shown that such enlargement is the result of diseases other than sleeping sickness. For the proper working of the law, enlarged cervical glands must be regarded as due to sleeping sickness unless a competent medical officer has certified that they are the result of some other cause. (For methods of examination see Memoir XVIII. of this School.)
It is indeed highly desirable that a competent entomologist be sent out to study the bionomics of tsetse flies. Very little is known of their habits, and it iş most important that investigations along these lines should be encouraged. So long as the habits of the tsetse flies are unknown, we are working largely in the dark in our efforts to check the spread of sleeping sickness. When their bionomics are fully known, it is quite possible that they may be dealt with in some way similar to that followed in the extermination of mosquitoes.
Yours, &c.,
A. H. Milne, Esquire.
DEAR SIR,
Enclosure 2 in No. 18.
ALLAN KINGHORN.
Seamen's Hospital Society, Dreadrought Hospital,
Greenwich, S.E., March 7, 1907.
Re Sleeping Sickness.
I BEG to acknowledge the receipt of your letter of the 26th ultimo, together with correspondence on the above subject. I have been requested to send you the enclosed communication from Dr. Daniels, the Medical Superintendent of the London School of Tropical Medicine, which I venture to think you will consider of some importance. This communication contains the views of the teachers in the School, and may be commended to your very careful consideration.
D. E. Brodie, Esquire,
British South Africa Company,
2, London Wall Buildings, E.C.
Yours, &c.,
P. MICHELLI,
Secretary.
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