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15.
136
Since that time these island sazas have been rarely visited. The villages and most of the plantations and the many well-built roads have grown up to dense jungle. A more remarkable and extraordinary incident than this exodus and voluntary expatriation of two entire peoples from a region in all respects but one an ideal place of residence is hard to seek. Reporting, in December, 1909,* upon the progress of the measures, the Governor (whose term of office was then expiring) repeated the statement made two years before :--
"
Only the seriousness of the situation could have warranted such drastic measures. When one realizes that most of the farms and homesteads from which these unfortunate victims were thus arbitrarily evicted had been the homes of their forebears for generations, one realizes the remarkable state of discipline under which these people have existed, and the extraordinary influence which their headmen still exercise over them. The chiefs, whose opposition to the wishes of the Government might, perhaps, have proved almost insuperable, loyally helped the Administration, even in cases where the necessary measures entailed on them considerable pecuniary loss.Ӡ 16. Thus the depopulation of the mainland shore and island sazas was carried out. In the following pages I have attempted to measure the actual effect of these extraordinary measures upon the progress of the sleeping sickness epidemic in Uganda.
Decrease in number of Deaths in Uganda Province due to Depopulation Measures.
17. In the despatcht already quoted it was remarked: "While we hope that by carrying out the measures recommended sleeping sickness may gradually cease to afflict the people of this country, any rapid decrease in the number of its victims must not be expected. The external signs by which the disease may be diagnosed usually do not appear for many months, and sometimes for years, after the infec- tion has been contracted. In spite of the measures which we now propose to take for the segregation of the sick and the protection of the healthy, a heavy death roll must be expected for two or three years to come."
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18. Between January and March, 1907, some 18,000 inhabitants appear to have been removed from the danger zone on the mainland. Two and one-half years later some 23,000 were removed from the islands, and there were no more left in Unquestionably the death-rate must contact with Glossina in all the Province.
have been affected, and a notable decrease in the number of deaths ought to have followed the mainland depopulation after the expiration of a period corresponding to the average length of life of the victims after contracting infection, and a similar decrease must certainly have followed two and one-half years later when the effects of the island depopulation were felt.
19. The length of life after contracting infection is indicated by the following death returns from the sleeping sickness camps in 1910 :—
Condition on
admission.
Early stages, "A"
Intermediate stages, Advanced stages, "C
Number of deaths.
25
"
B
31
223 327
Average length of life
after admission,
17.6 months.
13.7 months.
6.9 months.
It must be remembered that very few patients presented themselves before acute symptoms began to appear, and that some time must necessarily elapse after the disease is contracted before any symptoms appear. Also that there were many cases of desertion (in some camps in some months as many as of deaths) of the patients in the earlier stages, so that the more virulent cases made up the bulk of the deaths. All these factors make for a longer average length of life than indicated. Opposed is the fact that most of the cases in the camps were under treatment and that life So that eighteen to twenty-four was certainly prolonged in many of them.
months may, perhaps, represent about the real average duration of the disease.
20. Accepting this, it is plain that no effect of depopulation measures carried out during the first quarter of 1907 could be expected until 1908, but that they ought to be apparent in the death returns of that year. Similarly that no
Report on the measures adopted for the suppression of sleeping sickness in Uganda, by Sir H.. Hesketh Bell, K.C.M.G.-Colonial Reports, Miscellaneous, Uganda No. 65.
+ As an example of losses sustained, Kwebe, saza chief of Sease, lost 400 of his 800 head of cattle very shortly after they were removed to the mainland, presumably from piroplasmosis, of which the islands had been reputed free, and many more died subsequently.
No. 218, paragraph 49.
effects of depopulation in the third quarter of 1909 could be expected until eighteen months later, or until the calendar year 1911, but that notable decrease in mortality ought to take place during that year.
21. The Table I., presented herewith, bears this out, and thus confirms the conclusions reached the other way, for unless they be accepted it is impossible to find any effect of these so radical measures reflected in the death returns.* Table I.--Deaths by Sleeping Sickness in Buganda Province, including Sesse and Buvuma Islands.
Your.
Number
Increase or of Decrease over Deaths. Preocding Years.
Remarks.
Per cent.
1900
1901
8,430 10,384
+19
1902
24,035
+ 57
Probably far too high.
1903
12,891
-48
Recorded heretofore as 30,441. Error in compilation of returns.
1904
11,251
13
1905
8,003
28
1906
5,304
34
1907
3,407
36
1908
1,723
49
1909
925
46
1910
547
41
1911
253
54
1912
82
67
1913
57
30
1914
24
58
1915
2
- 87
To end of August.
About 18,000 inhabitants removed from fly zone during the first quarter Effect of depopulation noticeable.
About 23,000 inhabitants removed from islands during third quarter. No effect of depopulation.
Effect of depopulation noticeable after lapse of eighteen months.
Death Returns from Island, Mainland, and Interior Sazas respectively.
22. In Table II. the course of the epidemic on the islands and mainland is shown separately. Two points in this connexion are noteworthy,
23.
(1) That, when the mainland shore was depopulated in 1907 and the islands in 1909, a decrease in number of deaths occurred one year in advance of the time when any real effects could properly have been expected (vide paragraphs 19 and 21).
(2) That, coincidentally with this immediate reduction in number of deaths on the mainland, the number on the islands increased, and, similarly, when the islanders were removed to the mainland and fewer deaths were recorded amongst them, the number of deaths returned from the mainland suddenly increased.
Positive confirmation is lacking (and may never be secured), but I think
it probable that the obvious explanation is the correct one-that the depopulation of the Busoga and Buganda shores in 1907 caused the many Bavumu and Basesse temporarily residing there to return home with their sick.
24. It is thus believed to have had the effect of bringing into Buvuma, and thus into Buganda Province, a considerable number of Bavumu (and some Basoga also) who had been residing on the Busoga coast. This compensated for what would otherwise have been a still more notable reduction in number of deaths in 1907 (for the entire Province of Buganda), owing to general prophylactic and precautionary measures which were put into effect in Busiro (Entebbe) in 1906 (see Table IV.) and to the decreasing number of deaths in the western and more recently infected sazas. (For the first year since 1900 the epidemic was increasing in any saza.)
not
25. It may readily be seen that when, in 1909, it was attempted to ascertain the result of mainland depopulation, it was natural to attribute the decreased mortality upon the mainland during 1907 to the influence of the measures put into
*NOTE. There may not be much dependence placed upon the average length of life of sleeping sickness patients as calculated in paragraph 19. It was shorter with the patients dying in 1909, shorter still in 1908, and longer in 1911 This is due to there being some cases which lived far beyond the average, so that, as the epidemic tailed off and new infections grew less numerous, the proportion of the long lived cases grew rapidly.
This hardly affects the conclusion reached in paragraph 20, however. There must have been some effect of depopulation upon the death-rate, and no effect is shown except in 1908 and 1911.
But the survival of the semi-chronic cases who contracted the disease long before, but died during, the later years of the epidemic is a factor which makes for a still smaller number of new infections in the later years than the decreased number of deaths indicates.