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PUBLIC RECORD OFFICE

Reference --

CO.885

19 PUBLIC RECORD OFFICE, LONDON

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

44415

(No. 238.)

MY LORD,

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No. 53,

UGANDA

THE GOVERNOR to THE SECRETARY OF STATE.

(Received 4 December, 1908.)

Government House, Uganda, 3 November, 1908. IN a memorandum* of the informal discussions which took place at the Colonial Office on the 10th and 11th January last, between the British and German delegates of the International Conference on Sleeping Sickness, an account was given of the views expressed by Professor Koch concerning the etiology of sleeping sickness and the measures which he considered might be taken for dealing with the disease.

2. This memorandum was submitted by me to the Principal Medical Officer for an expression of his views thereon, and I now have the honour to forward herewith a minute by Dr. Hodges dealing with most of the points referred to by Professor Koch.

3. I also transmit copies of memorandat by Dr. Hodges on the following subjects:-

(1) Note on the question of sleeping sickness being caused by tsetse flies other

than G. palpalis.

(2) Note on the distribution of Glossina palpalis.

(3) Note on the clearing of landings, ferries, fords.

(4) Note on Dr. Bagshawe's discoveries of pupa and breeding places.

(5) Note on Dr. Bagshawe's report on flight experiments.

4. These papers are all of great interest and will doubtless be transmitted by your Lordship to the Sleeping Sickness Bureau. If, as I hope, they be printed in the form of a pamphlet, I beg that 50 copies may be supplied for circulation in this Protectorate.

I have, &c.,

D. C.,

Enclosure in No. 53.

(S. M. O. Confidential. No. 50/08.)

H. HESKETH BELL,

Governor.

I AGREE almost entirely with Professor Koch's views, as expressed in the discussion between the British and German delegates to the International Conference on Sleeping Sickness which took place on January 10th and 11th, 1908, at the Colonial Office, and at which I was present.

1

The work of the German Commission has confirmed the observations which have been made in the Uganda Protectorate, and Professor Koch expressed himself in entire accordance with the preventive measures which have been recommended and are now being carried out here.

In expressing his belief that the trypanosome passes through a developmental cycle in G. palpalis, Professor Koch produced no specific evidence in support of this and admitted that, up to the present, he had no such evidence to show. His opinion, though of very great weight and importance on such a point, is not shared by other observers of authority, such as Colonel Bruce, and I think the balance of our experience at present points the other way.

With regard to the destruction of crocodiles, I admit its expediency where practicable, and I have already recommended it, in my report made in 1906, in the neighbourhood of stations and other places of human concourse. Since, however,

• See No. 2.

↑ These memoranda have been published separately by the Sleeping Sickness Bureau.

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we have removed the lake-shore population, we have removed at the same time a greater source of food-supply from the fly than the crocodiles probably afford, and we have left no one by whom their wholesale destruction can be carried out.

I pointed out during the discussion that G. palpalis is omnivorous, as regards vertebrate blood, and that there is no essential inter-dependence between the crocodile and the fly, since there are extensive fly-areas on Lake Albert Edward where there are no crocodiles (Dr. Bagshawe's reports), and there are stretches of many miles along the Nile banks where crocodiles abound and there is no fly. G. palpalis is also present on many small streams where crocodiles are absent or where, even though they might occasionally visit them, they could not be supposed to form the main source of food-supply.

It is true that sleeping sickness was absent from those fly-areas observed on Lake Albert Edward where there were no crocodiles; but the region of non-infected fly-areas is by no means co-extensive with that from which crocodiles are absent, for the former extends northwards along the Semliki River and the southern half of the shores of Lake Albert, where crocodiles are found.

in

Professor Koch professed his belief in atoxyl as a cure for cases in the early stage of sleeping sickness, and advocated the multiplication of segregation camps order that the early cases might come more readily under observation and treat- ment. His estimate for the staff of such camps was, to the best of my recollection, one physician and one trained European assistant to each camp of 500 patients.

With regard to the transmission of sleeping sickness by coitus, I have never found any reason to believe that it can be conveyed by this means, and I thought that there must exist some undiscovered fallacy with respect to the cases brought forward by Professor Koch. A belief that sleeping sickness could be so contracted obtained at one time among the natives here, but I believe it is given up. When the epidemic first swept through the lake-shore district the men, whose employments naturally carried them into the greatest danger, usually suffered first. As the men weakened, their occupations, such as canoeing, were in part taken up by the women, who then ran greater risks and more often contracted the disease, while many of their husbands by this time had either died from it or showed obvious symptoms of its presence.

There is a disease. of horses, called dourine, in which it has long been known that the trypanosome is transmitted normally, if not solely, by means of coitus. But this is the only one of the many trypanosomes which have now been discovered, which is known to be so transmitted, so that this method of infection must be regarded as exceptional in trypanosomiasis. The trypanosome of sleeping sickness, that of nagana or "fly," and other trypanosomes, are known to be transmitted normally by the bites of certain insects; and there is no reason to suppose, from analogy, that one of these, any more than the others, can also be transmitted by coitus.

If sleeping sickness could be contracted in this way it would have spread from imported cases in all directions, in distant countries and independently of fly-areas. There is no evidence of this having occurred, and there are good reasons for conclud- ing that it does not do so. Nagana, and other animal trypanosomiases, if trans- missible by coitus, would also have spread in regions where their respective normal insect-carriers do not exist.

Professor Koch was of opinion that nothing practical could be done towards exterminating G. palpalis by attacking the pupa or the breeding places, but I think that Dr. Bagshawe's observations show that further investigation in this direction is needed and may prove to be of great value.

The dimensions which I recommend for cleared areas on foreshores are some- what understated.

I attach notes which I have by me on the question whether the infection of sleeping sickness is conveyed by tsetse flies other than G. palpalis; on fly-distribu- tion on lakes and rivers; and also a further note on preventive clearing and one on pupa and breeding-places.

I should like to circulate a copy of Professor Koch's views among the medical superintendents of the camps.

A. D. P. HODGES,

Senior Medical Officer, Uganda.