سسس
PUBLIC RECORD OFFICE
Reference :-
C.O. 885
22 PUBLIC RECORD OFFICE, LONDON
ALLY WITHOUT PERMISSION OF THE BE REPRODUCED PHOTOGRAPHIC- COPYRIGHT PHOTOGRAPH-NOT TO
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wesi to the Budongo Forest, will ultimately cause a very serious loss to human life in the fly-belts round Masindi. This loss of life will occur especially among the Europeans travelling between the Victoria Nile viâ Masindi to the Congo and the Soudan.
(See report for occurrence of fly on Masindi Port Road.)
8. In the great opening up of the Buruli District about to take place within the next few months the most stringent care must be taken to avoid the introduction of any of the human group of trypanosomes. The loss of life in Buruli would pro- bably be slight, but the fly and game would pass such a form quite rapidly to the great main artery of traffic round Masindi, where the fly are distributed in thick belts. Mules, donkeys, and domestic cattle are all capable of conveying this type of trypanosome.
9. T. rhodesiense, pre-eminently a morsitans trypanosome, is already present in German East Africa, and morsitans extends practically from the German border through Ankole and Katwe to the Northern Province. A narrow range of hills, and a fairly large area of well cultivated land, is all that separates Bulimwesi from the south-western belts. A trypanosome of the gambiense group with posterior nuclear forms was got by Dr. Duke from Ankole during his recent safari. (Report of Dr. Duke's safari in Ankole.)
10. Precautionary measures are urgently required. All cattle and mule trans- port must be stopped unless carried out under the most rigid and efficient micro- scopical examination and quarantine of the animals so employed. All roads in morsitans areas (especially and notably the Masindi Port to Butiabwa Road) should be cleared of bush on either side throughout its whole extent, and planted with some low-growing crop, such as cotton or sweet potatoes. The optimum width for the strip of cultivation must be ascertained by experiment. Grass should be system- atically burnt at least once yearly in fly country.
11. It cannot be too seriously urged that, owing to the presence of morsitans and large quantities of game, vast tracts of the Uganda Protectorate form at the present time an ideal environment for the fostering and dissemination of human trypanosomiasis.
12. Had T. rhodesiense been one of the species taken to Nakasongola in 1900, the Masindi Port Road and both the Masindi-Kampala Roads would, at the present time, be absolute death traps. To take any one species of trypanosome in the Masindi fly-belt, the fly are infected at least at the rate of thirty per thousand, and in Nyasa- land and Rhodesia a percentage of two per thousand has caused sufficient loss of life to call forth two commissions of investigation, and to seriously inhibit the development of certain parts of the country.
It may be added, as a rider of scientific interest, that the very high percentage of flies infected in the Masindi fly-belt is probably a mark of a recently infected district. In the course of some years the percentage will probably drop a little. Practically speaking, of course, the period of the very high percentage is of crucial importance. The explanation of this phenomenon is most likely to be sought in the fact that wild animals, while tolerant, do seem to acquire a certain immunity after a number of years. It is the young animals that are the really active members in the keeping up of the reservoir in a long established focus. In a new area, however, all the game are acting as members in the fostering of the trypanosome, hence a period of very high infectivity is produced in the fly during a period of years. There is no definite evidence as to the duration of this exalted condition, but it seems probable that once produced it would be maintained for some five or six years at least.
SIR,
Enclosure 2 in No. 63.
Principal Medical Officer's Office, Entebbe,
30th September, 1913.
I HAVE the honour to forward herewith two reports of Miss Robertson's researches in Bunyoro, in the neighbourhood of Masindi, and in the northern part of Buganda Kingdom, in Buruli.
2. These reports reveal a truly alarming state of affairs, and one that must be taken in hand at once, especially as regards the clearing of the Masindi-Masindi Port road.
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3. But even if we endeavour to safeguard the passengers along this main road, which is of great and growing importance, by clearing a wide strip along either side, we must not be content with that. The other main roads must be systemati- cally and thoroughly examined, and cleared where necessary; the whole of the Buganda Kingdom must be carefully mapped out to show the fly belts and areas; the infectivity of the fly must be determined, and the various trypanosomes must be mapped; 7. rhodesiense must be looked for; all cattle must be examined before movement from one part of the country to another is permitted; movement must only be allowed along certain clear roads; the game must be driven back from the main roads and from the cattle areas; the grass of the whole country must be systemati- cally burnt at least once yearly (as large an area being burnt at one time as is possible).
4. I have discussed this question fully with Miss Robertson and Mr. Hutchins, the Chief Veterinary Officer, and we agree that to carry out this most important work additional staff will be necessary and additional funds for both the Medical and the Veterinary Departments. I am compelled to ask for five extra temporary Medical Officers for three years (and Mr. Hutchins is also asking for additional men). These five Medical Officers, with the usual expenses, will cost a sum of £13,000, spread over three years: £5,000 next year and £4,000 the following years. The details of this expenditure are given on a separate sheet.
5. It might be suggested that this work should be entirely in the hands of the Veterinary Department. The importance of the measures proposed, however, lies in their relation to human life, and as the Veterinary Officers cannot undertake the examination of the population, I consider that the Medical Department should work with them in carrying out the work proposed.
6 The five Medical Officers would be given large districts, roughly as follows: Buruli, Mubendi, Buddu, Ankole, Bunyoro. I am not asking one for Toro, as it is hoped that the Medical Officer in charge of that district will be able to tour and do this work in addition to his other duties. This is impossible in any other district,
as the routine work of the station increases so rapidly that it is very difficult for a Medical Officer to leave his station.
7. In making these appointments picked men should be chosen who have had experience in bacteriological work and who are accustomed to perform sub-inocula- tion experiments.
8. Although fly-work (ie., accurate mapping, the behaviour of glossinidæ as to seasonal occurrence, the infectivity of the fly, &c.) will be the chief duties of these Medical Officers, they will be in addition District Medical Officers and will super- intend the measures against plague and small-pox which it is hoped will be shortly introduced (eide my report, No. 249/5, dated 4th September, 1913). They will also be of the greatest service in increasing our knowledge (which is at present very scanty) of other endemic and epidemic diseases in this Protectorate, especially leprosy, trypanosomiasis, cerebro-spinal meningitis, &c., and also as regards the condition of the game in their respective areas.
Another important work these Medical Officers could undertake is the examina- tion of those natives who apply for exemption from taxation or from Kasanvu labour on the score of sickness or old age. At present the somewhat anomalous position obtains of these exemption certificates being given by District Commissioners and Assistant District Commissioners, while the Medical Officer has no power to do so.
9. The importance of lessening the reservoir cannot be over-estimated, and I therefore recommend that all antelopes and buffalos be taken off the game schedules as regards that part of the Kingdom of Buganda and of Bunyoro to the east of the Kampala-Hoima and Hoima-Masindi-Foweira roads, until further notice. Owing to their danger, all mule and donkey transport must be stopped, unless passes are given by the Chief Veterinary Officer, and no officer on tour should be allowed to have either a mule or a donkey. This is most important, as they travel long distances and may spread infection very widely.
10. I will start the work of clearing the Masindi road at once, and pamphlets will be distributed to all chiefs and owners of cattle instructing them in the way to avoid tsetse.
11. I have not emphasised the danger which Miss Robertson has shown us to exist; I leave her reports to speak for themselves, especially the conclusions she
comes to.
12.
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In case it is argued that it would be sufficient to evacuate these tsetse-
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