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any facts in favour of this hypothesis. Professor Koch convinced himself that palpalis was the only insect carrier, and now that it is proved that a Glossina palpalis once infected may be capable of transmitting the human trypanosome to whomever it bites during a period of two months and more this has become still more probable.
The French observers, however, have expressed this doubt, and it is my opinion that, until the laws of transmission are more fully ascertained, those responsible for the medical supervision at ports in the tropics outside Africa are right in trying to prevent the introduction of cases of sleeping sickness, though I do not think that any harm will come if a few cases do pass the barrier.
(2) The ports concerned are those on the east side of tropical Africa, on the south and west, as far as the Cunene River, and Aden. There is no more evidence in favour of species of Glossing other than palpalis transmitting Trypanosoma gambiense than there is of its transmission by mosquitoes. Here, again, such species as Glossina fusca and Glossina tachinoides are looked on with suspicion; the first named occurs as a rule only in small numbers, and the last has not a wide distri- bution. No jury would convict Glossina morsitans, practically the most important which species, on the evidence before us, and Kleine in a well devised experiment, a large number of this species of fly was used, failed to infect a single susceptible animal. Most of the ports in question are more likely to receive cases of sleeping sickness from the interior than from the sea. Persons who are obviously infected should be forbidden to land, because once landed it is open to them to travel west- or north into palpalis areas; if they are allowed to land they should be confined to hospital.
(3) Should measures be taken to hinder the introduction by sea of infected natives from one palpalis area of tropical Africa to another? Practically this is the most important problem of the three, for labourers are moved in large numbers on the West Coast of Africa for various public works, and native soldiers are, I suppose, moved similarly. Seeing that there is no railway communication between the West Coast Colonies it is by ships that infected persons will be transported, if at all, from one Colony to another. It is certain that movement of persons who have contracted sleeping sickness should be prevented if possible; all such movements tend to spread the disease, and it is by this means that it has gained its present great extension. But, on the other hand, it must be remembered that the diagnosis of sleeping sickness at the present time is not easy. It requires time, knowledge, and skill, and often more than one examination. If the object is to keep out every case of the disease it will be necessary for expert medical officers to devote much time to the examination of passengers. If, on the other hand, it is sought to stop those only who can be recognised to be infected without the aid of the microscope, the end may be fairly easily attained; but it may be noted that no person with obvious trypanosomiasis should be shipped in the first instance. It is at the port of embarka- tion that supervision should be practised. For the present I consider that obviously infected natives should be prevented from embarking, and, if detected only at the port of arrival, should be prevented from landing or kept under medical supervision in a fly-free hospital or camp. To keep out all infected natives is, in the present state of our knowledge, hardly possible.
ARTHUR G. BAGSHAWE, Director,
Sleeping Sickness Bureau.
November 17th, 1909.
38653
No. 23.
EAST AFRICA PROTECTORATE.
THE ACTING GOVERNOR to THE SECRETARY OF STATE. (Received 27 November, 1909.)
[Copy to the Royal Society and to the Sleeping Sickness Bureau, 2 December,
1909. L.F. See No. 24.]
[Answered (No. 26) 13 January, 1910; (40719) in Miscellaneous No. 254.] (No. 622.)
MY LORD,
Government House, Nairobi, 4 November, 1909. WITH reference to your Lordship's despatch, No. 245 of the 7th of May last,*
L.F. transmitting copy of No. 9.
75
giving cover to a letter from the Royal Society urging that a conference of medical and veterinary officers should be convened to collect evidence and devise remedial measures with regard to human and animal trypanosomiasis, I have the honour to report that the desirability of organizing such a conference had already been recog- nized and the conference was held from the 26th to the 29th of April in this year with Sir David Bruce as president.
2. I now have the honour to enclose a copy of the first day's proceedings, which related to sleeping sickness, and to report that at the next meeting of the Legislative Council a draft Ordinance is being introduced embodying as far as is practicable the recommendations of the conference.
3. I should be glad if your Lordship would cause the Royal Society to bę informed in the sense of this despatch.
I have, &c.,
F. J. JACKSON,
Acting Governor.
Enclosure in No. 23.
PROCEEDINGS OF CONFERENCE.
First Day. President: Sir David Bruce.
Subject: Sleeping Sickness. AGENDA.
1.
Opening remarks by President.
2.
Statement by Dr. Hodges, as to the present condition of affairs regarding
sleeping sickness in Uganda.
(a) What has been done in regard to treatment.
(b) Methods employed to prevent the spread of the disease.
(c) Methods employed to stamp out the disease.
(d) Cost of administration.
(e) General results of.
3. Statement by Dr. Milne as to sleeping sickness in British East Africa.
(a) Treatment.
(b) Preventive measures.
(c) Stamping out measures.
4. Should the native population be removed from fly area.
5. To what distance from fly area should they be removed.
6. Removal of population from the Islands.
7.
8.
9.
Methods of [and] feasibility of such removals.
The question of the bringing of Kavirondo labour into the fly belts of British
East Africa.
The question as to medical treatment.
10. The policy of concentration camps.
PROCEEDINGS of a CONFERENCE, held at Nairobi, British East Africa, on April 26th to 29th, 1909, to discuss SLEEPING SICKNESS and STOCK DISEASES PREVALENT IN THE COUNTRY.
On the invitation of His Excellency the Governor, Sir James Hayes Sadler, K.C.M.G., Colonel Sir David Bruce, C,B., F.R.S., Director of the Royal Society's Sleeping Sickness Commission in Uganda, was invited to preside over the conference. Amongst those invited to attend the conference, the following were present Dr. Hodges, Principal Medical Officer, Uganda; Dr. Atkinson, of Molo; Lord Dela- mere, the Marquis Hornyold, Hon. C. C. Bowring, C.M.G., Hon. Colonel Montgomery, Commissioner of Lands; Hon. A. C. Hollis, Secretary for Native Affairs; Hon. Captain Cowie, Mr. Van de Weyer, Mr. Hobley, Provincial Commissioner; Mr. Ains- worth, C.M.G., Provincial Commissioner; Mr. Percival, Game Ranger; Mr. Sheen, Captain Riddell, Dr. Milne, Principal Medical Officer, East Africa Protectorate; Mr. Stordy, Chief Veterinary Officer and Acting Director of Agriculture; Mr. Anderson, Entomologist; Mr. Edmondson, Veterinary Officer.
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The first day's proceedings were devoted to sleeping sickness.
The President, in introducing the subject of sleeping sickness, stated that the species of tsetse fly known as Glossina palpalis was, under ordinary conditions, the only carrier of sleeping sickness. It was therefore most essential that the distribu- tion of this fly should be carefully mapped out; for it was by this means alone one could arrive at some idea of the limit of the infected areas, or of where probable extension of sleeping sickness might take place. With one exception, viz., Dourine, all known trypanosome diseases were transmitted through the agency of some biting insect. The importance, therefore, of mapping out the distribution of all biting flies became increasingly apparent. It was alleged, chiefly on the ground of labora- tory experiments, that Glossina fusca, Glossina pallidipes, Glossina morsitans, mos- Under natural quitos, and other biting flies might be carriers of sleeping sickness. conditions, however, Glossina palpalis was probably so much the predominant partner that the others could be left out of account. Recently Dr. Kleine, in charge of the sleeping sickness operations in German East Africa, had demonstrated in the Glossina palpalis a development cycle of the trypanosoma gambiense. He proved that the fly was capable of transmitting infection after eighteen and up to at least sixty days. The President pointed out that the life of a fly might be anything up to a year or more. Dr. Kleine's experiments had since been confirmed in the Sleeping Sickness Laboratory in Uganda. In support of his contention that Glossina palpalis was the sole carrier, he showed by a series of maps how, in Uganda, the dis- tribution of the Glossina palpalis areas coincided exactly with the occurrence of sleeping sickness.
The President, in concluding his opening address, stated that the fly (Glossina palpalis), ordinarily speaking, was only to be found within a short distance of the lake shore; it did not exist where grass land or bare rock came down to the water's edge, but, on the other hand, it was found where there were clear rivers with sandy hanks and requisite shade. Where papyrus existed the fly was not found.
Dr. Hodges pointed out that, where measures for removal of the inhabitants from contact with Glossina palpalis could be effectually applied, the death rate had been greatly reduced, instancing figures from the Kingdom of Uganda as follows :--
In 1905 there were 8,003 deaths recorded.
In 1906
*
11
In 1907
"J
11
In 1908
**
11
5,304 3,407 1,730
"
35
"
11
"
In comparison with these figures representing the total death rate, he drew attention to the death rate obtaining in the Sesse archipelago, where preventive measures had been much less completely enforced than on the mainland, and where it had not been possible to remove the bulk of the inhabitants from contact with the fly.
Total for mainland and
islands combined.
Deaths on the
islands.
In 1905
3,503
In 1906
1,719
In 1907
In 1908
1,992 1,177
Deaths on the
mainland.
4,500
3,585
1,415 553
8,003
5,304
3,407
1,730
It must be borne in mind, in comparing these figures, that the island population is much smaller than that of the infected mainland.
So far, medicinal treatment had proved unsatisfactory. Segregation camps had proved useful in educating the natives regarding the nature of the diseases, for experimental treatment, and in attracting natives to remove out of infected areas. In the management of the camps no force was used. Should a native run away from the camp, he was reported to his Chief and kept from re-entering the fly area. had always considered the camps inadequate for purely segregation purposes. his opinion there were only two methods by which the disease could be stamped out :---
(1) By keeping the population away from the fly.
(2) By destroying the fly.
He
In
The latter method was practicable only for the vicinity of townships and for certain limited areas along traffic routes. His experience had shown that in
safe
distance. average removing people from the lake shore, two miles was a absence of fly from extensive papyrus swamps he attributed to the fact that they were
The
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impenetrable for man and beast, and formed barriers to the fly's migration and dis- tribution.
He thought it likely that the preventive measures used against sleeping sickness in Buganda Kingdom might require to be modified for application in East Africa, and that the difficulty in dealing with the disease might prove greater, since he under- stood that the conditions more nearly resemble those existing in the Congo and Nile Valley, where the extension of fly inland along numerous rivers caused the fly-free areas in the interior to be more limited in extent and less definitely circumscribed.
He believed that for dealing with sleeping sickness in the East Africa Protec- torate a special staff of medical officers would be needed, whose numbers would depend on the extent of the area infected, on the number of its inhabitants, and on the local conditions obtaining in the infected area. Uganda had eight medical officers specially dealing with sleeping sickness.
Until the discovery of a specific cure suited for application to large numbers of natives, the only practical means of dealing with the disease was the removal as far as possible of the entire population from contact with the fly. He pointed out the importance not only of removing all infected persons from such contact, but of pre- venting the return of infected populations to fly areas until infection has been stamped out among them. He also pointed out with regard to the discovery of Professor Kleine, mentioned by Sir David Bruce, that its bearing on this class of preventive measures was of less significance than might at first appear, because, although the previous supposition that the fly's infectivity lasted only 48 hours was now controverted by the fact that this infectivity might last for 60 days and probably a great many more, it had long been known that infected human beings remained infective for years, and must therefore be kept from contact with fly areas indefinitely. Professor Kleine's discovery had, however, a very important bearing on other points in connection with sleeping sickness, such as the employment of non-infected persons in previously infected fly areas and the re-population of infected zones from which the inhabitants had been removed by natives from non-infected districts.
The native Chiefs of Uganda had long realized the necessity of removal from infected areas so far as the deporting of their own households was concerned; though for pecuniary reasons they had until lately been inclined to leave their vassals to suffer.
Dr. Milne said that the conditions prevailing in East Africa were similar to those in Uganda, viz., the infected areas lay along the lake shore and extended up the various rivers. Roughly speaking, the population affected was between 30,000 and 40,000. Owing to the fact that, until the present year, there were no medical officers detailed for this special work, such information as was known regarding the extent of the spread of the disease had been obtained by rapid surveys of members of the permanent medical staff. That portion of Southern Kavirondo which was adjacent to the Anglo-German boundary was the only part on which any accurate data had been collected. The fly limit, more particularly along the banks of the rivers Kuja and Majori, had been determined, and, from the results of the investiga- tions among a population of approximately 13,000 people, it would appear that between 7,000 and 8,000 people were infected with trypanosomes.
Owing to the necessity of first determining which areas in the province were fly-free, and capable of supporting an influx of population, it was not until the commencement of this year that a start could be made with the formation of a segregation camp. Acting on the six years' experience of Uganda, no force was used to induce natives to reside, in the camp, but an active propaganda towards this end had previously been carried out throughout this district. Patients who came into camp were fed at Government expense, but no special effort was made towards medical treatment, the idea of the camp being to serve mainly as a bait to the sick and so gradually attract their kins- men and thus depopulate the infected zones. As a small beginning among natives whose intelligence was not equal to the Baganda, the camp had had a fair measure
of success.
One hundred and sixty-six patients had placed themselves under the care of the Medical Officer in charge during the three months it had been established. While in Uganda there were eight Medical Officers engaged specially on sleeping sickness works, East Africa had one only. It was satisfactory to note that, for the coming year, an extra Medical Officer had been sanctioned.
Dr. Milne concluded by exhibiting a map showing the distribution of sleeping sickness past and present in the Kisumu Province.
Lord Delamere urged the necessity of mapping out the fly areas. He considered that money should be voted specially for that purpose. He desired to know the