PUBLIC RECORD OFFICE
Reference :-
C.O. 885
ALLY WITHOUT PERMISSION OF THE BE REPRODUCED PHOTOGRAPHIC- COPYRIGHT PHOTOGRAPH-NOT TO
22 PUBLIC RECORD OFFICE, LONDON
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In Wenchi, where the percentage of infection has previously been high, the sub- chief was rather opposed to examination owing to the number of deaths in people whom he was told were suffering from the disease, but in whom he could detect no illness at the time. These deaths occurring in people who had been examined had led him to suspect that we were doing more than examining his people, even though he had been present throughout the proceedings. The north country people in the zungos are far more difficult to examine. As regards gland puncture, I had practi- cally no trouble, even with small children, so long as the needle was not displayed before their eyes. I have examined in all 39,742 natives in 196 towns and villages. and found 110 cases, 23 old, and 87 new infections. One of these new cases is not included in my statistics, as it was only discovered after they had been made out. These new infections Of these 87 new cases, 49 were males and 38 females. include:-
36 pure north country natives.
11 Ashantis with a north country strain.
17 Gamans.
1 Timminy from Sierra Leone.
22 Ashantis.
I should not be inclined to say that the last-named are all pure Ashantis, because in the earlier part of my investigations I was misled by simply asking if an infected " Ashanti." I found person was an Ashanti or not. The answer invariably was out afterwards, however, that the so-called pure Ashanti had occasionally a north country mother or grand-mother. I won't say this was always the case, because in Imany instances I was informed that the parents and grand-parents were of pure Ashanti origin.
It must not be thought that these 110 cases are all that are in the Province. North country carriers are constantly passing through, among whom are bound to be Some infected ones, and apart from these there must be some in the pre-glandular stage of the disease who were overlooked. I have also come across a few people uffering from delusions and nervous conditions with no glandular enlargements, These are not but whom I strongly suspected to be suffering from the disease. included in my statistics, as to confirm my suspicion spinal puncture would have been necessary, and this I did not consider justifiable under the circumstances.
That this disease is endemic in the Western Province is well known, but this endemic condition is almost entirely confined to the towns on the main road and the adjacent villages. The view I hold is that this endemic condition is kept alive by north country slaves and their descendants, and not by the pure, healthy, indigenous native, and that the north country carriers who are constantly using the main trade roads, and living in the Ashanti villages on these roads, and among whom are many trypanosome carriers," are largely responsible for keeping up his endemic condition. I won't say that all these trypanosome carriers are north country natives because I have found several, strangers to the Province. who call themselves Ashantis, carrying infection about with them. A point which I think is important, is where do these north country natives receive their infection? Do they bring it down from the orth, or do they become infected in the endemic area to which they come? I should be inclined to take the latter view, but I must say that I know nothing about the country from which they come, except that cattle and horses which thrive, in north Countries, such as Moshi and Wangara, are found on their arrival here to be infected with trypanosomes, to which they gradually succumb if not killed beforehand. understand there are cases of trypanosomiasis found in the Moshi country, but whether these cases have travelled or not, I am unable to say. Moshis in this Pro- vince seem to be susceptible to the disease. as I have found several infected among the few I have examined. I don't know if there is much human trypanosomiasis among the inhabitants of the Northern Territories of the Gold Coast. I only saw one case in Lorha in twelve months, and that was in an old soldier who had been in Ashanti. Why does not the disease spread more in villages where the infected have been known to reside since 1910, even though the vector of the disease is constantly met with in these villages Dr. Kinghorn wrote in 1910: "I am inclined to think this trypanosome in the course of time has lost much of its virulence by being com pelled to pass through a long series of resistant individuals after the susceptible ones had been swept off, and this has gone on to such an extent that it can now culy establish itself in these natives with some difficulty." With this I entirely agree.
We know from the history of the disease that it is a very old one on the West Coast, and it is highly improbable that the Ashantis escaped it, owing to their
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numerous expeditions. From the very chronic course it takes, especially among the indigenous population, I should be inclined to think it is a mild strain of trypano- some we are dealing with.
At least 20 of the 97 cases found in 1910 are still alive, and 9 of the 32 cases found in 1911-12, probably more, as many left the Province and could not be traced. Some of the 1910 cases which I saw appeared to be in good health, though they have not received treatment. On going through these 1910 and 191f cases it is rather noticeable that the north country natives seem to succumb to the disease more quickly It is also notice- than the indigenous natives, provided they have not had treatment. able how frequently these north country slaves and their progeny seem to he picked out by the disease, when the indigenous population show no signs of infection.
I shall quote a few examples:-
I may
In the Berekum division, starting from Odumase and proceeding south on the main road to Bechem, on the border of the Province, one finds the following:
Odumase.-Six cases of the disease in the Zongo among north country natives, and not a single case in the Ashanti town, although there were only 80 people examined in the Zongo, while there were 564 Ashantis examined in the town. say the Zongo in Odumase is practically a continuation of the Ashanti town, and the Ashantis are constantly in the market place during the day. One of these infected north country people has been living as long as eight years in the Zongo.
Sunyani.-There were two deaths from the disease recently, both said to have been Ashantis. At the present time there are three cases here. Two of these three infected people are the sons of north country slave mothers, and the third was born in Togoland, his grand-mother having been a north country slave.
Tanosa (on the main road).—The only case found in three years was that of a north country slave.
Nquanta--One case in three years, a stranger to the town.
Bechem-Two cases in three years, one a native from Kwahu, the other a north country native from Hausa country.
Tekimentia (in the kola district).—Three cases in three years, one of these was the grandson of a north country (Moshi) slave, one a north country slave, and the third a north country (Wangara) kola carrier.
Jemo.-A town some distance from the main road, in the kola district. One case, a north country woman from Moshi.
Chriemaisu (in the Wam division).--Out of 265 people examined three cases were found, and all of these proved to he north country slaves. They had lived in the town for years.
Nquatia and Koradusu.-Dr. Kinghorn found six cases in these two small settle. ments near Coomassie, the inhabitants of which were the off-spring of Wangaras slaves.
I could give more examples like the above, but they are all to be found in the lists appended to this report.
It is unlikely that the north country slaves who have lived in this country for years were infected at the time they were introduced into Ashanti, and certainly the children of these slaves born in the Province and now found infected must have received their infection in the Province. I am inclined to believe that these infected north country carriers, instead of bringing the disease with them from the north become infected in the endemic areas into which they come. I take it that the present strain of trypanosome, while finding a difficulty in establishing itself in the pure healthy indigenous native of the Province, does not find the same resistance when introduced into these north country strangers.
I have made no attempt to study the morphological characteristics of the human trypanosome as found here, but consider research work of such a kind very neces- To have attempted such work in many of the miserable shelters in which I had to live would not have proved satisfactory.
sary.
Clinical Observations.
As I had very little opportunity of following up any of the cases of the disease, it is difficult to say much under this heading. I was considerably struck by the appearance of the skin in many of the infected cases, especially those who had suffered from the discase for some time. The crescentic erythematous patches seen in white-skinned people suffering from the disease could not be detected in the natives, but in the adult natives the skin [was] frequently seen to be rongh, dry, and
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