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C.O. 885
22 PUBLIC RECORD OFFICE, LONDON
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considerably the work they are doing on their side. Their complaints have been formulated by Dr. von der Hellen, and a translated copy of his Memorandum is attached.
5th October, 1913.
APPENDIX 1.
C. V. LE FANU.
Supplementary proposals to the Agreement concluded between the German and British Governments with a view to combating sleeping sickness in Togo and the neighbouring British territory, suggested by Dr. von der Hellen :-
The object of the above Agreement, which aims at making yet more effectual the campaign engaged upon by each Power in its own territory, and which provides for this purpose measures dependent for their utility on the local conditions-after having been in force now for two years--appears not to have been attained. It would be welcomed if the British Government would declare itself prepared to consent to the following proposals. Failing such consent I would consider a renewal of the Agreement, after it had lapsed, as undesirable, as it would only serve to convey an impression to laymen that each Power was doing everything possible to combat the disease; this, how- ever, unfortunately is not the case.
Proposals.
"(1) In the districts adjacent to the boundary in which the existence of sleeping sickness and of the fly concerned in its spread has been deter- mined, examination of the natives for sleeping sickness shall be made as nearly as possible at the same time. As soon as one Power has decided on repeated and systematic examination on its side, the other shall undertake a similar proceeding. The latter, however, need not undertake such examinations more often than twice a year.
(2) The Government concerned may make permission to cross the boundary and reside in its territory dependent upon a previous examination for sleeping sickness. Should the existence of the disease be proved or strongly suspected, then the Government concerned must either provide for treatment-as in the case of its own subjects--or hand them over to a recognised authority of the other.
In the case of such persons who frequently cross and re-cross the boundary, the Medical Officers may, with their consent and after ascertaining the absence of infection, affix some visible mark, which would be destroyed on attempted removal (for instance, a band with leaden seal). Natives with enlarged cervical glands, the cause of which cannot be proved due with certainty to some other condition (tuber- culosis, injury, &c., &c.), only these should be considered as not. suspicious of infection, when a negative result is obtained after exami- nation by puncture on two separate occasions. Persons supplied with such distinctive marks may be allowed to cross the boundary for a period of three months without further medical examination. To facilitate control the date of examination should be impressed on the seal. (3) In the case of traders coming from the north, both Powers should practise an identical form of supervision intended to prevent a spread of the disease. For this purpose, both will undertak. examination at the same time, not later than the arrival of such persons in districts where infection is possible, dealing with them as suggested in para- graph 2, only with this difference, that the lower concerned will treat infected cases in a like manner as its own subjects.
"(4) Natives found infected, and who have attempted to avoid treatment. by flight into the territory of the other Power, or such as have escaped from a camp' before having been officially discharged,' are to be extradited on request.
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'(5) Persons who have been treated for sleeping sickness in one country, and are subject to that country, but have migrated to the other before their 'final discharge,' on request by the former shall either be sent back or submitted to an observation' similar to that practised by it. "(6) Persons who have crossed the boundary with the intention to escape examination shall be sent back on request. That this intention existed shall always be presumed when the boundary has been crossed after announcement has been made in such persons' village of a proposed medical inspection.
"(7) The Medical Officers engaged on sleeping sickness duty shall be entitled to address requests for extradition directly to the local authorities concerned."
Dr. von der Hellen continues:-
Owing to the different methods practised by Germans and English in their respective Colonies in dealing with the natives, conditions have arisen in the course of time which have greatly added to the difficulties of dealing with sleeping sickness in Togo.
It might be of interest to recall the opinions held by English medical men of the methods of combating sleeping sickness practised in Togo and in the Gold Coast. In 1910, after a visit to us, Dr. Horn remarks on "the excellent work being carried on in Togoland"; further, as to the manner by which we succeed in getting natives to appear for examination: "In Togoland the inhabitants of the towns are registered and known to the Administration, so that the entire population can be to a great extent checked; whereas in this Colony there is no such possibility, as we have no system of registration, and there is nothing to prevent natives from tempor- arily leaving a town and hiding, rather than undergo a medical examination against their wish. Legislation will probably be needed to compel the chiefs and villagers to present themselves for examination by a Medical Officer when called upon."
Dr. Oakley reports on a tour along the German-English boundary from the At Vhegbe junction of the Daji to the Volta, at Asekuma, south-east of Anum:
I had a number of people for gland puncture, but as soon as I started on the first case the others all ran away and refused to come back. The people absolutely refuse to submit to gland puncture. Many people in this district should be examined in this manner, but as there is no law to this effect, one cannot coerce them. In Togoland there are laws to make the Chief have all his people in the village at a certain time to meet the Medical Officer; to make all the people submit to a thorough examination, and to make them come to hospital when found, to be suffering from this disease. I respectfully suggest that this matter should be placed before His Excellency the Governor (in Council) to see whether some law could not be passed to help the Medical Officers in their work. Without it we cannot find the early cases, and thereby people who may be a source of great danger to the community are walking about without taking any particular precaution."
Alluding to above, Dr. Hopkins, Principal Medical Officer, writes in the "Sleep- ing Sickness Bulletin, 1912," page 129: "The Governor does not favour the suggestion that suspects should be subjected to compulsory gland puncture, but prefers persuasion."
page 204), advocates a systematic Dr. Rice ("Sleeping Sickness Bulletin, 1912," campaign on similar lines to that in Togoland." And again (page 358), "has advo- cated the establishment of a camp similar to that at Misahöhe at Banda, in the northern part of Ashanti. His (?) impression is that the authorities in the Gold Coast are not doing all that they might and could in the investigation of sleeping
sickness
APPENDIX 2.
Agreement.
With a view to the more effectual combating of the disease known as sleeping sickness in the Gold Coast Colony, the Ashanti Protectorate, the Northern Terri- tories of the Gold Coast, and in Togoland, His Britannic Majesty's Government and the Imperial German Government have agreed as follows:-
The said Governments shall-
1. As far as the means at their disposal allow, cause the most thorough investi-