CO885-(20-21) — Page 24

PUBLIC RECORD OFFICE

Whil

C.O.

Reference :-

885

20 PUBLIC RECORD OFFICE, LONDON

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

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VII. That, owing to our lack of knowledge as to whether we have in this country the conditions necessary, in the light of our present knowledge, for the production of endemic centres, namely, the presence of Gl, palpalis with imported cases of the disease, I am of the opinion that the increase of the medical staff recom- mended in my last letter should be delayed until further investigations have been made on this point. If as the result of these investigations Gl. palpalis is found to be at all widely distributed this increase of staff should be sanctioned at once, as it would be necessary that the areas in which this species of Glossina is found should be immediately defined and the population removed beyond its range, before imported cases had infected such areas.

VIII. That, owing to the very wide distribution of Gl. morsitans and our lack of knowledge as to whether this species of Glossina is to be incriminated in the spread of the disease equally with Gl. palpalis, no measures that would be effective can at present be adopted in preventing the hypothetical spread of the disease by Gl. morsitans. The only effective measure would be the removal of all villages beyond the range of the fly, a work which could only be undertaken when definite proof is obtained that this fly is a natural transmitter of the disease, owing to the enormous labour and expense entailed, and the difficulties-political and otherwise that would be met with in the removal of several hundred thousands of people from their homes.

As regards Gl. fusca, I am of opinion that the removal of villages within the range of this fly should be undertaken. In Uganda T. gambiense was experi- mentally transmitted by Gl. fusca, and therefore should be equally incriminated until further proof is obtained.

The general conclusions enumerated above have been carefully considered, and, in my opinion, should form the basis of any immediate measures to be adopted against the spread of sleeping sickness in this country.

I have prepared a scheme for His Excellency's consideration and approval detailing the means I propose to adopt for giving effect to the above conclusions. The immediate work required to be done is of a threefold nature:-

1. To obtain conclusive evidence as to the presence or otherwise of

Gl. palpalis.

2. To segregate all imported cases, and especially those in localities where G. morsitans are abundant. This to be done by systematic palpation of the natives in such localities.

3. To provide an effective line of defence against the introduction of infec

tion from endemic sleeping sickness areas, and especially from the Tanganyika region.

The systematic carrying out of measures under these three heads must be the primary duty of the medical staff for some time to come.

I have, &c.,

SAM, K. NORRIS,

Acting Principal Medical Officer.

SCHEME of immediate measures to be adopted for dealing with Sleeping Sickness. I. For purposes of investigation the northern portion of the country is divided

into four sleeping sickness districts :-

1. The Karonga district and south to the S. Rukuru River.

2. The West Nyasa and Mzimba districts south to the Dwanga River.

3. The country south of the Dwanga River to the southern portion of the

Central Angoniland district.

4. The Fort Johnston and Upper Shire districts.

II. To prevent the introduction of infected cases from without rules should be made under the provisions of the Contagious and Infectious Diseases Ordinance, 1903, declaring the foreign countries of German East Africa, the Congo Free State, and that part of North-Eastern Rhodesia within the sleeping sickness boundary laid down by the Administration of that country, sleeping sickness areas.

One or more places to be determined by the Board commanded by His Excellency to meet for this purpose, and hereinafter called "entry" places, shall be specified,

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at which alone it shall be lawful for persons to enter the Protectorate from the sleeping sickness areas, and all persons arriving at such entry places shall be detained there until examined by a medical officer and permitted or directed to proceed elsewhere.

No person shall enter or attempt to enter the sleeping sickness areas from this Protectorate unless provided with a special permit by the Resident. Such permit shall only be given for special reasons, and on it shall be stated the route to be followed and any other conditions subject to which the permit is given.

No canoe or other boat shall be allowed to ply at the north end of Nyasa or on the Songwe River, between German East Africa and this Protectorate, unless a permit to ply has been obtained. Such permit shall be obtained from the Resident or other European officer in charge of the "control" operations, and shall be limited to the period during which, and the purpose for which, it is valid, and such terms and conditions shall be observed and complied with.

Natives employed in the transfer of goods may have permits granted to them to proceed to certain places to be decided afterwards, subject to the conditions for which the permit is given; on such permit must be stated the route to be followed, the destination, and any other conditions subject to which the permit is given. The European employers will be held responsible for the strict observance of such condi- tions, and the return of his employees through the same entry place, and will also provide for their examination on their return by a medical officer.

To make these measures effective a strict control shall be maintained along a boundary formed by the Songwe River as far west as a point to be decided, and then due south until it touches the North-Eastern Rhodesia boundary, and then along the North-Eastern Rhodesia boundary until about the 10th parallel. This control shall be made effective by a police patrol and by the subsidising of the native chiefs along the boundary line to hinder and arrest all persons who try to cross except at the "entry places" specified.

No native shall enter this Protectorate from the " guard area" except at certain specified points of entry, at which a permit to enter must be obtained. By the term guard area is meant that portion of North-Eastern Rhodesia outside the sleeping sickness boundary. This will not apply to local natives living con- tiguous to and crossing and recrossing the boundary from adjoining villages, but to strangers travelling from some distance. boundary should be subsidised for the work of hindering the entry of all with the The native chiefs living along the exception of local natives, except at the specified "entry places." trouble, in my opinion, this plan would work well in practice. The same rule shall After a little also apply to natives leaving the country in search of work. They should only do

so under permit and at the specified "entry places."

The entry places" will be considered at the meeting of the Board commanded by His Excellency to meet for this purpose.

III. To investigate and map out the distribution of the different species of Glossina, and especially to determine whether Gl. palpalis is present in the Protec- torate or otherwise, and, if so, the limits of its distribution.

For this purpose I propose to employ four medical officers, one in each of the four districts above mentioned.

Dr. Davey is at present engaged in this work in the North Nyasa district. His instructions are to systematically search the lake shore and the rivers flowing into the lake northwards from Chintechi until he reaches the Songwe River. He will then investigate the Songwe and any other portions of the North Nyasa district he may deem advisable.

Captain Hardy has been instructed to investigate the lake shore north of Lintipe River until the outlet of the Bua River into the lake is reached, when he will proceed to investigate the Bua and its tributaries near the mouth. He will also search the estuaries of the different rivers flowing into the lake between these two points.

Dr. Pask, the Medical Officer at Fort Johnston, has been instructed to investi- gate the lake shore, commencing at Nkudzi Bay and following the shore round the Livingstone peninsula until he reaches the Lintipe River. As this work would occupy some time, and as he has other duties in addition at Fort Johnston, I pro- pose, as soon as Captain Hardy reaches the Bua, to instruct him to return and commence investigations at the Lintipe, and continue southwards until he joins hands with Dr. Pask.

I also propose that Dr. Shircore, who will almost immediately be relieved by