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Enclosure in No. 8.
THE LIVERPOOL SCHOOL OF TROPICAL MEDICINE EXPEDITION TO THE ZAMBESI, 1907.
Madona, 31 January, 1908. DEAR MILNE,
YOUR cable of the 19th ultimo only reached me two days ago. Two or three days after you had sent it, you should have received my letter of November 15, and a little later the one dated December 18. In these I indicated the chief observations thought ought to be I had made, and also suggested a few measures which adopted. We are drawing up a fuller report now, and this will be forwarded next week so that it ought to be in your hands early in March.
I enclose a copy of a letter which I have sent to Barratt, and have asked him to let the Principal Medical Officer of Nyasaland see it. You might send it on to the Colonial Office with copies of my other letters unless this has already been done.
We have met with some delay in getting carriers, but as soon as they arrive we intend making for the north end of Nyasa as quickly as the work will permit. Probably we shall be there in about four months' time.
I hope you are watching for anything which is appearing on sleeping sickness. It is absolutely necessary that we should be kept up to date. Now that you have a sleeping sickness conference of your own, you will doubtless have all the latest information at hand.
Yours, &c.,
ALLAN KINGHORN.
THE LIVERPOOL SCHOOL OF TROPICAL MEDICINE EXPEDITION TO THE ZAMBESI, 1907.
Madona, 28 January, 1908. DEAR DR. BARRATT,
I TRUST that by this time you have settled down comfortably, and are finding the work up to your expectations.
concert,
doubt if we can do much to aid While we are supposed to work you directly in your blackwater work, but if you will let us know any points you would like us to look for, we may, perhaps, be able to do something. I have been travelling continuously since reaching Broken Hill, and this, with the work of examining the natives, has left me little time for outside work. Montgomery has been doing work on the treatment of cattle with atoxyl and mercury, and thinks that the indications are favourable.
Doubtless you will be asked about the sleeping sickness work, and I should like to give you a short synopsis of our results to date.
As regards "fly,” G. palpalis has been found on both sides of the Luapula, from Kapwepwi's to Kasiwa's, a village about two days south of Lake Mweru (by Spillane and me). It has also been found by Dr. Spillane along the whole of the British coast of Mweru, around the south end of Lake Tanganyika, and also along parts of the larger confluents of the Luapula and Kweru, notably the Mansa and the Kalung- From Kasiwa's wisi. I found it on the Luongo, a short distance from its mouth.
to Mweru, on the British side, the Luapula is bordered by swampy plains some miles in width, so that the conditions are unfavourable for this fly. On the Belgian side this does not obtain to such an extent, so that fly is probably present, although I have no definite knowledge as to this. G. morsitans, and possibly the closely related pallidipes and longipennis is widely spread over the country, however. On the road from Broken Hill to Fort Jameson, I found them at one spot in the Machinga Hills, from the base of these right across the Luangwa to within a day of Petauke, and near the Sasare mine. From Fort Jameson to the Luapula they occur from the Luangwa to the base of the Machingas. There is a sudden rise here to the plateau of 2,500 feet or so, and on top of the hills I did not see fly again until I got to the Kasanka River. In this vicinity they are very plentiful, and stretch over to the Luapula and up north past Chitambo's through the country to the east of Bang- weulu. They may be said to be found in most of the Luapula Division.
I have found three cases of sleeping sickness in the course of my work, all with a history of having worked in the Katanga mines. All had markedly enlarged glands, and, at the time I saw them, appeared perfectly healthy. Fly (G. morsitans) was present in the village of at least one case. Considering the thousands from this country who have worked in the Katanga mines. I am perfectly convinced that there are many more cases scattered through North-Eastern Rhodesia, as the labour was not drawn from any one particular district.
As you are aware, all the work which has been done goes to show that the
33
transmission is mechanical. While I think this is not sufficient to account for the rapid spread of the disease in view of the great difficulty experienced in getting positive results, it is a fact which cannot be too strongly emphasized. There is too great a tendency to regard G. palpalis as the only infecting agent. That this is not so has been shown by the work in Uganda, where successful transmission experi- ments were made with G. fusca. Again, the work on cattle trypanosomes shows that while one or two species are normally concerned in the extension of the disease, it is quite possible to effect this by the use of not only other species of tsetses, but also other distinct genera, e.g., Stomoxys and Tabanids. This surely is sufficient to demonstrate that, at present, all biting flies and particularly all species of Glossina might refer, in this connection, to the report must be regarded with suspicion. that some observers in the Congo Free State implicated Stegomyia fasciata. Whether there is any truth in this I cannot say. While, perhaps, the task of con- trolling the spread of sleeping sickness would become impossible if every Liting insect had to be considered, it is not so with regard to the tsetse flies, and I would The hope that on every occasion on which you have the opportunity you would emphasize the importance of not simply regarding G. palpalis alone as dangerous. question of the etiology of the disease is in a more unsatisfactory condition than the treatment, at all events from the prophylactic view, and it is most important that some definite effort should be made to find exactly what flies, tsetse and others, are capable of carrying the virus.
FL
" "+
-
As to enlarged glands, I have found that a fairly large percentage of the natives (roughly 30-40 per cent.) have palpable glands, which come chictly under the +
group of Dutton and Todd's classification, though there are also glands. On puncture these were found to be uniformly a number of negative. This occurrence of enlarged glands rather complicates the diagnosis, for it means that the statement "every negro with enlarged glands must be considered, until the contrary is shown, to be a case of trypanosomiasis" cannot be accepted for North-Eastern Rhodesia, and, presumably, for Nyasaland as well. Consequently a trained medical officer is the only person who can look for the disease satis- factorily, since puncture is necessary. I have advised that the British South Africa Company should have special medical officers to travel through the country looking Whether it will be necessary for like for cases, and getting them isolated at once. measures to be taken in Nyasaland is uncertain as yet.
The chief danger for the Protectorate lies in the spread of the disease to the north end of Lake Nyasa. Trypanosomiasis is endemic on Tanganyika, at Vua, in the Free State, a short distance above the Congo-Rhodesia Lorder, and between the people on either side of this there is unrestricted communication. G. palpalis is Whether the found right around the southern end of Tanganyika, so that it is extremely probable that cases of the disease are present in that part of the country. disease is to be found in German East Africa in this neighbourhood is not known. At the north end of Nyasa G. fusca has been found, and this, we now know, can carry the disease. If once a case gets over where these flies occur an epidemic might easily be started. I believe natives of the Protectorate are carrying loads from Karonga to Kasama, and as large numbers of natives from the Awemba District of North-Eastern Rhodesia have worked in the Katanga, cases probably exist amongst them, and the possibility of them infecting negroes from Nyasaland must not be overlooked. It therefore seems to me that the north end of Nyasa is the part which requires most attention from the authorities of the Protectorate. It would also be well to bear in mind that natives of the Protectorate have been Some of these working in the Katanga, and some are only returning home now. may be infected; and, in fact, I should not be at all surprised to hear at any time that cases of human trypanosomiasis had been found in Nyasaland.
As soon as we get carriers we intend to travel across to the north end of Nyasa in order to examine the conditions there personally. We should be there in four or five months at the outside.
If there are any points you would like to have cleared up with regard to this letter, or if there is anything we can do for you, I hope you will let us know at once. Please address me at Abercorn.
Yours, &c.,
Dr. Barratt,
3265
Blackwater Expedition.
Blantyre, Nyasaland.
ALLAN KINGHORN.
E