CO885-(18-19) — Page 20

PUBLIC RECORD OFFICE

Reference :--

EPERE C.O.885

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18 PUBLIC RECORD OFFICE, LONDON

ALLY WITHOUT PERMISSION OF THE BE REPRODUCED PHOTOGRAPHIC- COPYRIGHT PHOTOGRAPH-NOT TO

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any particular place or places, but must be removed to fly-free country, and, as far as possible, will go to the inland estates of those chiefs on whose lands they have previously lived, where they will form, it is hoped, new and healthy settlements.

Such a procedure as this, it seems to me, is the only one approaching to thorough- ness by which we can hope to check for the time the extensive and omnipresent traffic which radiates from the lake shore, and which is shown in the above report to be responsible for the great bulk of the infection in this epidemic. This traffic, which shows an enterprise most creditable to the natives concerned, and which, apart from sleeping sickness, would be of the greatest use in developing the country, need not, it is hoped, he indefinitely stopped or even greatly curtailed, hut, for the present, it is imperatively necessary to check it as far as possible, especially since, so far as it affects the food supply and the necessities of existence, it is nowhere and by no means indispensable, unless it may be to some of the islands, for which special arrangements can be made if it be found necessary.

SIR,

(No. 78/S.S.E.)

(Enclosure 1 in, Appendix F.)

Entebbe, October 20, 1906. I HAVE the honour to inform you that, in view of the success recently reported from Europe in the use of atoxyl as a cure for sleeping sickness, and of the hopeful opinion as regards its curative properties expressed personally by Professor Koch, the distinguished head of the German Sleeping Sickness Commission, I consider it advisable, although no certain cures can be scientifically demonstrated for some considerable time, and possibly for some years yet, that measures should be taken as soon as possible to test this drug on a large scale among the natives of the Uganda Protectorate.

For, whatever may be the ultimate result as regards cure, it is certain that preparations of arsenic are beneficial and often lengthen life in human trypano- omiasis, besides lessening the risk of infection by banishing the trypanosome from the glands and peripheral circulation, so that such cases for the time being cannot infect the fly and cease to be a danger to the community. It is a fact also that atoxyl is a less poisonous preparation of arsenic than any hitherto known, and can, for this reason, be given in larger quantities, is safe and suitable for hypodermic administration, and is far more applicable for general distribution among the thousands of sick natives with whom we have to deal than any drug which has previously been proposed as a cure.

I consider, therefore, that not only is it justifiable to incur very considerable expenditure in giving it an extensive trial as a curative agent, but that the measures undertaken for this end may be so ordered as to assist materially in carrying out the most important general measure which is at present open to us, namely, segregation of the sick, which His Excellency has now in contemplation.

I would suggest, then, that a central camp be chosen and prepared in advance in each important county or district affected by sleeping sickness; that such camps be situated in fly-free country, of which the Sleeping Sickness Extended Investi- gations have shown that there is plenty to choose from in the interior (see Note 1); and that they should be at a sufficient distance outside the nearest fly-range to minimise both the expense of strict policing and also the appearance of constraint, by making it difficult for irresponsible and demented patients and others to wander back into the infected zone.

I would also suggest that all buildings and shelters at these camps be of a temporary nature, so that a camp could be shifted easily and without much expense it necessity arose, as, for instance, the outbreak of some other epidemic such as * small-pox, the occurrence of insanitary conditions or the insufficiency of food or

water.

Since there is plenty of safe country from which to choose, the selection of sites need only primarily depend on medical and hygienic conditions and their exact location would be determined by administrative reasons and native interests. As regards sleeping sickness the following centres would be advantageous (see Note 2): Northern Busiro, Northern Kiadondo, Northern Chagwe, Northern Mawakóta or Western Buddu, West-Central Busoga, the neighbourhood of Masindi (for Unyoro),

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the neighbourhood of Fatiko (for Nile Province), and the centre of Buvuma for the Northern Group of Islands, this last being necessary if we are to avoid an inrush of islanders, of whom a very large number (perhaps 80 per cent.) are already infected, into the less highly infected mainland.

The German Sleeping Sickness Commission has already its camp established in the Sese Group, and will probably be able to serve that district for the present as regards treatment. The duration of its stay is, however, unknown, and in any case its camp cannot serve the purpose of segregation, so that later on an additional camp will be needed for the Sese Islands.

The construction and management of these camps would be adapted to segrega- tion, and they could ultimately become villages or settlements rather than camps. The question of food will be an important one to be considered, especially in fixing sites, but as a general rule Government could only supply free food to such patients as are helpless and without friends.

I feel sure that if their proposed use for atoxyl treatment were published among the natives, such camps would have great attractions for all those sick people along the fly-infested lake shores and river banks whom we wish to segregate and would form the safest means of segregation at our disposal, since all will probably be anxious to avail themselves of the new medicine, of the comparative success of which many of them have already heard rumours.

I do not propose that the atoxyl treatment be carried out on the lines of strict scientific experiment and investigation at more than one of these camps, since for this a much larger increase of staff would be required than is here contemplated. but it would be necessary to have one experimental camp, which would probably be the one in North Busiro. This would be started first, and, as soon afterwards as the necessary staff becomes available, camps for atoxyl treatment and segregation might be opened in the following order :-Unyoro, Usoga, Buvuma, Chagwe. Kiadonda, Buddu or Mawakota, and the Nile Province. This last would probably be for treatment only, since it is doubtful if segregation would be possible there.

In all I have recommended nine camps or centres, including that which will eventually be required for Sese. In order to place all these in working condition I estimate that an increase of at least five temporary Medical Officers will be required, and, in view of the fact that this work, if undertaken, should be commenced as soon as possible, and carried on without break or hindrance, and that three of the Medical Officers at present engaged in the Sleeping Sickness Extended Investigations will be due for six months' leave in April and May next, I consider it necessary that the services of these extra Medical Officers should be available in Uganda by April, 1907, at the latest. In making this estimate I allow two Medical Officers for the Investigation Camp and one each for the eight Treatment Camps, as I consider that, for treatment only, not more than one European will be required to take charge of a camp. This staff of Europeans, if kept at constant strength, constitutes the minimum which will be needed for the efficient carrying out of the medical work proposed. It is impossible to say, until the details of the administration of these camps can be worked out, whether the Medical Officers in charge will be able unaided to undertake it in addition to their other duties.

A subordinate staff, consisting of one hospital assistant and eight compounders (Indians) (see Note 3), will be needed, the first for the Investigation Camp and the others for the Treatment Camps, at each of which the Medical Officer will require an assistant who can read and write and help both in the care of cases and in the keeping of records. Whatever treatment might be adopted and whenever its use may be undertaken arrangements very similar to the above would, in my opinion, be inevitable. The scheme of segregation now in contemplation by His Excellency needs such arrangements and appears to me altogether advantageous for the purpose of treatment on an extensive scale.

On account of the many thousands of the sick and of the vast area over which the disease is spread it would be essential, under any circumstances, to have at least as many centres of operation as I now propose, while it would be equally necessary to fix them outside the fly-range, since any concentration of persons for whatever purpose within the infected area would lead to disastrous results in the further spread of the discase.

In such camps as I have named there would be no danger whatever of infection to the Medical Officers and attendant staff, nor, indeed, to any non-infected person: and for this reason there is no need to choose sites far removed from centres of

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