PUBLIC RECORD OFFICE
السلسة
Reference :-
PCO 885
9 PUBLIC RECORD OFFICE, LONDON ALLY WITHOUT PERMISSION OF THE
BE REPRODUCED PHOTOGRAPHIC- COPYRIGHT PHOTOGRAPH-NOT TO
Resumé of results of
investi-
gation.
Action of the tsetse
fly.
Measures. recom- mended.
Segrega- tion of the infected.
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23. The investigations, which have been carried on during the past five years, have resulted in the collection of a certain amount of information concerning sleep- ing sickness, which may, I think, be broadly summed up as follows:-
(1) That, prior to the outbreak of the disease, tsetse flies were quite as abundant in Uganda as they are now, but that no ill effects seemed to attend their bites.
(2) That the disease, generally speaking, is now almost always transmitted from a sick person to a healthy one by the bite of a tsetse fly (Glossina palpalis).
(3) That sleeping sickness may, in some cases, be transmitted from an infected
animal, but that the risk from such a source is almost nil.
(4) That the presence of even a single diseased person, in a locality infested by tsetse flies, may entail the infection of the whole community.
(5) That the disease so far, appears to be incurable.
(6) That a tsetse fly is able to retain the power of infection for a limited period. Some experts give a limit of two days, others 14, while others consider the limit to be undefined.
(7) That a more or less extended period elapses between the bite of an infected
fly and the appearance of the characteristic signs of the disease. (8) That there are no authenticated instances of the transmission of the disease from sick persons to healthy ones in districts where the tsetse fly is not found.
(9) That the tsetse fly is nearly always found in the near neighbourhood of fresh water, where the vegetation is luxuriant and shade abundant, That they are only found where those conditions exist, and that the infested belt is a narrow one.
(10) That the flies quickly abandon places where, through the clearing of
vegetation, the conditions favoured by them are removed.
24. If the foregoing deductions are correct, the tsetse seems to be the indis- pensable link in the chain of infection, and it would therefore appear that only by its elimination can the spread of the disease be checked. We should conse- quently either remove all tsetse flies from infected areas, or else withdraw all infected persons from fly-infested regions.
25. It is generally believed that, though fiies can be driven away from certain areas by the elimination of wild vegetation, they are so remarkably abundant all along the Lake shore that their wholesale destruction does not appear to be practic- able. The alternative measure, however, seems to be within our power, and we may hope that, by placing all sick persons beyond the reach of the tsetse, we may thus prevent the flies from procuring the means of further infection. After a compara- tively short period, the insects would no longer be capable of transmitting the disease, and they would become no more dangerous than they were before the appearance of sleeping sickness in the country.
26. I submit, that, failing the discovery of a therapeutic cure, it is only by the complete removal of all sick persons from the fly-infested districts that we can arrest the spread and progress of the disease, and I recommend to your Lordship the transfer to fly-free areas of the whole remaining population of the districts in the immediate vicinity of the Lake shore. I would, however, exempt from this decision those places, such as Entebbe, Jinja, and one or two other localities where by the complete removal of vegetation on the border of the Nyanza, tsetse flies have been almost completely eliminated. Even in the case of those places, however, I propose to so regulate the location of the natives as to render them free from all
risk.
27. The separation of the infected from the healthy is no new idea, but, for some reason or other, has never been acted on. The instructions, given by Lord Lansdowne in April, 1902, for the segregation of sufferers were based on the assump- tion that the disease was of an infectious or contagious nature, and we have already seen that those directions were allowed to remain in indefinite abeyance in conse- quence of Colonel Bruce's discovery of the agency of the tsetse fly. In November, 1904, Sir Patrick Manson, in a letter to the Foreign Office, stated: "The disease is not infectious in the usual sense of the word, but the deportation or isolation of any case of sleeping sickness that might declare itself is an obvious precaution,
107
menda-
medical
and the only one that, in my opinion, is practicable in present circumstances." Also, Recom- in December, 1904, Colonel Will, the Principal Medical Officer, advocated systema- by tic and radical measures for arresting the spread of the disease. He recommended that "every person residing in an infected area should be examined for the or otherwise of sleeping sickness, and registered and classified into groups, accord-
presence authorities. ing to the stage of the disease in those affected. It would then be possible to exhibit on an extensive scale remedies likely to be effective at the different stages of the disease. It would also be possible to carry out and ascertain the effects of Segregation.
The procedure which I venture to suggest will entail a very considerable expenditure, but if it leads to the discovery of a remedy, either curative or preventive, the beneficial results to both the inhabitants of the country and conse- quently to the Government would more than repay any reasonable outlay." Doctor Hodges, also, on more than one occasion, seems to have advocated the segregation of sufferers, and their removal from the Lake shore.
28. It may be assumed that questions of finance prevented action being taken on these excellent recommendations, and it was, doubtless, also hoped that the researches of the six special officers, engaged for the special study of the distribution of the fly, would have brought facts to light which might have an important bear- ing on the suggestions made by Sir Patrick Manson, Colonel Will, and Doctor Hodges. As a matter of fact these researches have, so far, only confirmed previous discoveries, and it may be taken as certain that if persons suffering from sleeping sickness be permitted to enter into districts, now apparently free from disease, but wherein tsetse flies are found, sleeping sickness will sooner or later declare itself, and the mortality will depend upon the facility with which the flies can act as carriers of the poison between man and man.
29. It is to be feared that, in many places, the mischief has already been done. In the Wadelai District, for instance, the mortality has been terrible, and it is estimated that over 2,000 persons have died within the last 18 months in a com- paratively small area. In Unyoro there are now believed to be many hundreds of cases, while in the districts bordering on the Mpologoma, in the Mount Elgon District, thousands have died.
30. After very careful consideration of the whole matter, and in consultation with my medical advisers, I now feel myself justified in recommending immediate action on the following lines:-
(1) The removal of all infected persons to fly-free areas, and their treatment Line of
by medical officers in specially organized camps.
action now
(2) The temporary removal of all healthy persons from areas infested by flies recome
that are presumably infected.
(3) The elimination of flies, as far as possible, in all localities from which the population cannot be removed, and in all places through which travel- lers are obliged to pass.
(4) Further investigations into the life-history of the tsetse with a special view to the discovery of conditions that appear to be inimical to the fly.
(5) The study of curative agencies.
31. I believe that I may safely state that the execution of these recommenda- tions will not entail any unreasonable degree of expenditure, and that a provision of £11,000 in the first year, £8,000 in the second, and £6,000 in the third, will be ample to cover everything. The gradual decrease in the amounts required is based on the assumption that there will be a steady reduction in the number of persons, afflicted by sleeping sickness, who will require treatment at the expense of the Government.
mended
cative
32. During my recent tour through the Protectorate, I had many conversations Favour- with the chiefs on the subject of sleeping sickness and was agreeably surprised to able find how ready and willing they appeared to be to accept any proposals which I attitude of would make for the repression of the disease. It is doubtful, however, whether authorities. their assistance would go to the length of the expenditure of much money by them, but I was assured, on all sides, that my suggestions, respecting the segregation of the sick and the removal of the healthy from the infected districts, would have their cordial concurrence. Two or three years ago, such suggestions would, I am told, have met with only a grudging acquiescence, if not covert opposition, and the
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