CO885-(18-19) — Page 543

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treatment by atoxyl does not, therefore, get a fair chance. The death-rate among the patients has been 26 per cent on an average, and it is increasing. The unsophisticated natives associate the place mainly with the idea of death and shun it accordingly.

24. The other camps are much more popular but, as very advanced cases continue to be received, the death-rate is bound/to increase and an unfortunate impression will probably soon be attached to them also. I hope, however, to get the chiefs to clearly explain to their people the reason for the high death-rate, and to especially impress upon them the far greater chances of recovery when the disease is treated in its early stages. I am inclined to believe that it would be advisable to keep the patients in separate wards, according to the severity of their disease on admission. The death-rate in each section would then be instructive and would probably have some good effect on the present popular notions.

25. If the segregation of the sick be not compulsory, the success of medical efforts on an adequate scale will largely depend on the attractiveness of the camps. The funds at the disposal of the Government are so restricted that we can do no more than give a bare sufficiency of the cheapest food to the destitute patients, and as most of them belong to that class, the cost is already comparatively high. Several of the chiefs have been very generous in sending presents of milk, Lutter, and even cattle to the camps, but these feasts are so few and far between that they are not much of an attraction. An intense craving for meat is a marked characteristic of sleeping sickness, and I think that if it were possible to give the patients a meal of beef or mutton now and then, the effect on those outside the camps would be excellent. It is possible that the sympathy of the charitable in England may be enlisted in this connection, and I propose to make an attempt in that direction.

It has, up to the present, not been possible to secure the required staff of hospital assistants and we have consequently had to maintain two doctors at each camp instead of one. As soon as the required men arrive, three medical officers will be freed for their proper duties, and additional camps will then be estab- lished in the hinterland of the Usoga shore and also, possibly, in Unyoro. There appear to be great difficulties in the way of establishing a camp in the island of Buvuma, and I therefore only propose to station a doctor there who will treat the afflicted natives at a clinique or in their own homes.

26.

27. The supply of food to the segregation camps is becoming a matter of much difficulty, especially in the case of Buwanuka. The natives still believe sleeping sickness to be an infectious disease and are much afraid of going near the camps. The situation is being met by the creation of plantations of bananas and of sweet potatoes the staple foods of the country—and it is hoped that, in a year's time, a sufficient supply of provisions will be available on the spot.

28. It is evident, from Captain Gray's report, that the real curative value of atoxyl in the treatment of sleeping sickness is still far from having been proved. Its effect on trypanosomes in the peripheral circulation seems to Le undoubted, but it is, apparently, too early yet to judge of its permanent influence on those parasites. Dr. Van Someren reports that distressing symptoms have frequently followed the administration of the drug, and though many of the cases under treatment and observation have benefited generally to a great extent, it is by no means certain that the improvement will be permanent. It will be borne in mind that very few of the cases have been under consecutive observation for more than a few months, and Captain Gray is of opinion that no case could be considered cured until the lapse of at least two years after the last injection of atoxyl.

29. The good and uniform quality of the atoxyl now being supplied is open to doubt, and any uncertainty on this score will, of course, seriously affect the value of all experiments that are being made with the drug, Captain Gray has drawn attention to the very large number of cases of blindness (amaurosis) which have recently occurred among patients who have been under atoxyl treatment during six months. The drug lately supplied by the manufacturers differs undoubtedly from that which was first sent out by them. It is difficult at present to say whether the blindness is a consequence to be feared from the use of atoxyl generally or whether the unfortunate cases now noted may not be due to some fault in the preparation of recent consignments of the drug. Captain Gray is making enquiry into this serious question, and the attention of the Principal Medical Officer has been drawn to it. A special report on this point will shortly be sub- mitted to your Lordship.

30. Subject to some assurance against risk of blindness from the use of atoxyl,

PUBLIC RECORD OFFICE

Reference :-

C.O.885

19 PUBLIC RECORD OFFICE, LONDON

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