PUBLIC RECORD OFFICE
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9PUBLIC RECORD OFFICE, LONDON
ALLY WITHOUT PERMISSION OF THE BE REPRODUCED PHOTOGRAPHIC- COPYRIGHT PHOTOGRAPH—NOT TO
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any definite results he was removed from this work and instructed to attend to other diseases; also that no report has been received here as to the condition of his investi- gation and to the probable reason of the negative character of his work as far as it had gone. It is greatly to be desired that this work should be resumed, either by the organisation proposed in section II. of this letter, or by an observer selected by the Royal Society, and paid out of public funds.
(3.) Whether the trypanosoma of sleeping sickness is T. Gambiense or a distinct form. This important enquiry can be partly undertaken by the Royal Society's observers, but the co-operation of the local authorities is much to be desired. A number of early cases of trypanosomiasis should be kept under careful and con- tinuous observation, and for this purpose a selection of prisoners serving long terms of imprisonment should be made use of, seeing that it is almost impossible to keep an ordinary individual of the native population under prolonged observation. When the large prison at Entebbe is occupied, it may be possible to find there twenty or thirty cases of trypanosomiasis, or failing that number, probably natives enough with trypanosomata in their blood could be found at Jinga, Kampala, and other prisons and be sent into Entebbe. Besides these enquiries, the observers, whether of the Royal Society's Commission or of the medical staff recommended in section II., should carry on animal experiments with the blood of early cases of trypanosomiasis, especially in the white rat, following Dr. Plimmer's experiments; and they might usefully cultivate the trypanosoma on the lines followed by Messrs. Novy and McNeil.
(4.) Much further investigation is urgently needed in regard to the medicinal treatment of sleeping sickness. The Royal Society would therefore propose that the authorities in the Protectorate be instructed to allow the Society's two observers at Entebbe, Messrs. Gray and Tulloch, to have under observation prisoners under- going long sentences who are found to have trypanosoma in their blood. Some of these would be left without medicinal treatment, others might be treated with arsenic, others with trypanrot or other material. In this way some advance might be made in testing the effect of drugs, and in obtaining means of alleviating or even arresting the disease. The advantage is obvious of dealing with patients who, in the case of prisoners, are isolated and can be easily watched from day to day for con- siderable periods of time.
II. It appears to the Royal Society that a large amount of valuable assistance in the investigation of sleeping sickness might be obtained from the magistrates, medical officers, missionaries, surveyors, native chiefs, and other persons resident in the Protectorates. The medical officers, in the course of their usual duties, could make observations which would be of great use, and might carry on some parts of the scientific investigation in collaboration with the members of the Royal Society's Commission. But the amount of observation and enquiry that requires to be under- taken is obviously beyond what could fairly be expected from these gentlemen in addition to their ordinary duties.
The Royal Society would therefore recommend that in order to accomplish the work now proposed to be undertaken, the medical staff in the Protectorate should be increased by, if possible, six medical officers, so as to set free the same number of the present members who, from residence in the region, have gained local knowledge of the place and of the habits and language of the people. The duties of these six officers thus set apart might perhaps be placed with advantage under Dr. Moffat, C.M.G., who has all along taken an active interest in the enquiry and is himself a member of the Royal Society's Tropical Diseases Committee. Having relinquished the post of Principal Medical Officer, he may now be more free to undertake the task proposed. Though independent of the Royal Society's Commission, it is confidently anticipated that the local medical staff detailed for these duties would work in concert with the members of the Commission for the attainment of the knowledge that all are anxious to secure. Dr. Moffat would no doubt be willing to report at intervals, say, every three months, as to the progress made by his staff, and thus the Tropical Diseases Committee of the Royal Society would be kept in touch with the progress made in the whole field of investigation. Some of the subjects of enquiry which would be most effectively pursued by such a body of local officials as is here proposed, are stated in the accompanying memorandum.
III. The attention of His Majesty's Government is earnestly directed to the necessity of taking steps to prevent as far as possible the spread of the scourge of sleeping sickness. Captain Greig, a copy of whose memorandum is herewith enclosed, has shown that the disease is spreading northward, and he points out that the
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question of diverting the traffic from the route at Fajao on the Nile is worthy of serious consideration. The Royal Society would be glad if His Majesty's Govern- ment could enlist the co-operation of the Egyptian Government in taking steps to watch the progress of the disease in the Nile Valley, and to devise such measures as may seem practicable to limit the passage of infected individuals into tracts of the flybelt where the disease has not yet appeared.
IV. The Royal Society would be glad if His Majesty's Government could make such arrangements with the Governments of Germany, Portugal and the Congo Free State as would ensure that copies of all official reports published by them, dealing with tropical disease, would be furnished to the Society.
I have, &c.,
ARCH. GEIKIE,
Enclosure 1 in No. 1.
Secretary, Royal Society.
MEMORANDUM OF ENQUIRIES recommended by the Local Authorities in Uganda.
(i.) A careful mapping out of the distribution of the various species of the tsetse flies over the whole area where sleeping sickness is spreading or seems likely to spread. As the disease may possibly be carried by several or all of the species of these flies, there is an obvious danger of the disease spreading outwards in all direc- tions from Uganda.
This enquiry should be started without delay in Uganda, and every available assistance from the local population should be made use of. The distribution of the fly on the Nile between the Ripon Falls and Fajao likewise calls urgently for attention.
It would also be well, as part of this investigation, to institute a careful search for the presence of the fly on any of the rivers which show open water, such as the Karu, and to find out if possible under what conditions the flies are enabled to extend so many miles inland in Usoga, while in Uganda they are restricted to the lake shores.
(ii.) A more complete determination of the areas wherein sleeping sickness occurs and on a larger scale than has hitherto been attempted. The necessity of this investigation is obvious. If, for example, a large number of natives were required for work in the Nile Valley or elsewhere, it is most important that they should be taken from a district absolutely free from the disease. Again, if natives were taken from an area of sleeping sickness into a district where a tsetse fly abounds, the disease would be at once communicated to the natives of that district. As no large scheme for prevention can be attempted until these areas have been mapped, it is obvious that no time should be lost in undertaking this work. Since the autumn of 1903 little has been done by the officials, chiefs, and others to add to our knowledge of the distribution of the fly and of the disease. Had this work been continued since then it might, not improbably, have been by this time completed.
(iii.) Certain of the physical features of Uganda appear to offer for the study of sleeping sickness advantages of which, if found practicable, use might be made. The numerous islands separate the population into more or less isolated communities. If one of these islands can be found, say, of 500 inhabitants, and having little or no connection with the other islands or with the mainland, a special study could there be made of the diseasc. If a medical officer were stationed on this island, his first duty would be to examine every member of the small population to ascertain the presence or absence of trypanosomata in the blood. He might then be able to say whether all cases of early trypanosomiasis went on, or developed into sleeping sick- ness, and to satisfy himself whether any practical means could be found of destroy- ing the tsetse flies in the limited belt under his observation. He would require to set up a small laboratory in a healthy part of the island and keep up record of his blood examinations, &c. In an island of this size, with a manageable population and with the co-operation of the head men, there would probably be no great difficulty in keeping the whole population under observation for some time. In such an experiment, the medical officer might also see if it is possible to teach the natives
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