CO885-(18-19) — Page 23

PUBLIC RECORD OFFICE

गय

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Reference :-

C.O.885

18 PUBLIC RECORD OFFICE, LONDON

ALLY WITHOUT PERMISSION OF THE BE REPRODUCED PHOTOGRAPHIC-

COPYRIGHT PHOTOGRAPH-NOT TO

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the proboscis but also from the alimentary tract, and sent in for to determine if possible the nature of the trypanosomes present. hly gorged flies should be captured and examined to determine the (mammal, bird or reptile) on which they have fed, and from these also ould be sent in.

of the most important questions at the present stage of the investiga- ig sickness are, that of the occurrence of a cycle of development of the in G. palpalis and that relating to whether the trypanosome of ess can be carried by other species of tsetse flies. Any observations s which medical officers may be able to make, or any material they may d in which might assist enquiry on these heads may prove to be of alue.

question which may prove to be of importance is that of the relative male and female flies. On this point it will be more difficult to carry ch, but any information bearing on it will be of great interest.

18 will be supplied which should be amplified, and corrected where th the aid of local officials of the administration, who will be able to the location and in the naming of villages, streams, &c. On these ent and position of the various fly-areas and of sleeping sickness I be indicated as exactly as possible, the former by red and the latter by

g

al epidemics of sleeping sickness are to be enquired into, mapped and ith respect to origin, imported and local infection, number and propor- ns attacked, the relation to fly-areas, the nature and frequency of n with neighbouring fly-areas, the occupations of the natives, the of the spread of infection as regards direction and the possibilities of I outbreaks resulting in various districts. pidemics or recently infected villages will demand most careful study, regards origin and the transmission of infection to or from surrounding

ical record should be kept of the sick in epidemic areas, distinction between imported and locally infected cases and between the stages of

which cases are found at the time of investigation.

es of sleeping sickness occurring in persons (especially children) pposed never to have visited an epidemic or infected fly-area should be

enquired into with the utmost care and reported fully by name. cial investigations should be made as to how far it might be practic- epidemic area, by removing huts or villages for a short distance (e.g. bank to the next hill-side) to place them outside the fly-area, and also,

the sick with water and perhaps other necessaries obtained within the eep them from contact with the fly.

asures would greatly reduce the risk of infection wherever they could it, for, although the apparently sick form only a proportion of those cted, they a Jord immensely greater opportunities to the fly and, further, uggested recently by Koch that probably only advanced cases are able fly.

amination of the lymphatic glands should be systematically carried out lations living in connection with infected fly-areas and in those living

ide such areas. It should be remembered that in sleeping sickness the ads are soft to the feel, somewhat like a ripe damson, and are not hard

amination for trypanosomes by gland puncture should be made where medical officers should proceed with caution in this matter till they the confidence of the natives (see paragraph 23). One dozen spare be supplied with each hypodermic syringe so that a separate one can ach puncture, the needles used being afterwards sterilized by boiling. method of procedure for the operation is as follows:-Draw into the tle 1 per cent. citrate of potash solution and eject it again, leaving the syringe and needle moist; then puncture the gland, move the needle y in the gland, draw out the piston, disconnect the syringe from the fraw the needle, attach the syringe again and blow out the contents of

to a slide. A thoroughly clean slide and coverslip are essential. is most important to enlist the sympathy and interest of chiefs and

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. other natives of influence. Opportunity should be taken to acquaint them with the appearance and habits of G. palpalis and specimens should be shown in order to test or aid their knowledge of them. The connection between the fly and sleeping sickness should be explained, how the one is probably powerless to spread the disease without the other, and how important it is to remove huts and villages from within the actual fly-areas and to prevent the sick from remaining in or even visiting such areas, wherever such measures appear possible. Special stress should be laid on the fact that the fly is harmless unless it can bite the sick. It is important also to explain to them the intentions of the Government, which wishes to prevent disease and to see the natives numerous and well-off, and a point might be made of the large sums of money being spent for these objects. As the native immediately seeks a motive to explain any action which he cannot understand, and as he has great difficulty in understanding that Europeans (or others) would do him a good turn for nothing, that is, without some immediate selfish end in view, investigators may, unless care be taken to explain, just as likely be credited with the intention to spread, as with the desire to prevent, sleeping sickness. Any misunderstanding of this nature even in one district would be likely seriously to affect the whole field of

nquiry and cannot be too carefully guarded against.

23. Every effort should be made from the outset to conciliate and gain the confidence of the natives, who should be dealt with as far as possible through their local chiefs. Methods of observation such as gland-puncture should be used at first with caution and discretion and in no case arbitrarily or without permission. But an attempt should be made to accustom the people gradually to such proceedings, so that later on their use may become more generally applicable and so of greater

scientific value.

A patient attending for treatment of an ordinary ailment, for example, might readily submit to gland-puncture, whereas a person casually encountered in a village might strongly object. Again, though the glands in the neck are the most generally adapted for puncture, yet sometimes a patient who objects to puncture in the neck, an operation which he cannot see, will offer no objection to puncture of his supracondyloid glands, a process he can watch, and, since these glands are quite frequently enlarged in sleeping sickness, and yield trypanosomes when punctured, advantage might be taken of this fact.

24. The use of rewards or gratuities should be avoided as a rule, and it will be found less expensive in the long run, as well as more advantageous, to use them in the case of voluntary interpreters or guides who may have gone out of their way to give information and assistance rather than to actual patients. It may, however, sometimes be required to reward patients as being the first to come in or to submit to operation or examination, or the price of food may have to be supplied to such as come from a distance and are kept for a short time under observation. A supply of pice should be carried for these purposes.

25.

All provisions and commodities obtained locally from natives should be paid for at the local rates.

26. All expenses, including transport, are chargeable to a special fund under the Head" Special Expenditure, Sleeping Sickness," and money can be drawn from Collectors locally by vouchers under this head. Exact accounts of all items are to

be kept and cash-books will be provided.

It will be understood that strict economy is to be used.

27. Medical officers should seek the co-operation of officials of the administra- tion and avail themselves to the utmost of their local knowledge and experience of the natives. Their advice or assistance with reference to such matters as roads, maps, guides, interpreters, local prices of native food, local native prejudices, occupations and methods of communication should be of great help in conducting the investigations.

28. It has been arranged that interpreters for the local dialects or languages will be supplied wherever possible by the local administrative officials. This is of the first importance both for facilitating the work and for gaining the confidence of the natives. Different interpreters may be required or be available for different parts of the same province.

29. Medical officers should pitch their camps outside of actual fly-arcas. In so doing they will find, as a rule, no difficulty in keeping in close touch with the investigation they have in hand.