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Enclosure 1 in No. 4.

Accra, 5th October, 1913. SIR,

On the 14th September last I was given an opportunity of visiting the sleeping sickness camp near Misahöhe 'in the German Colony of Togo, and I have now the honour to submit my report.

As my stay in the camp was only one of a few hours' duration and as my pre- vious knowledge of the disease in its various aspects was certainly not that of an expert, you will not expect a valuable addition to the volume of information you have already at your disposal.

My report is little more than a resumé of the work of other men and an account -inaccurate, no doubt, in many details-of what I saw and heard.

I am greatly indebted to my colleague, Dr. von der Hellen, for the kindness with which he received me and the information he gave me.

I have, &c.,

C. V. LE FANU,

Medical Officer.

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From there it extends along the "Oti " and its tributaries in a direction north and slightly east to Sansane-Mangu.

The distribution of the tsetse fly corresponds with that of the disease, Glossina palpalis prevailing in the southern portion and Glossina tachinoides in the northern to the exclusion of the first.

In Misahöhe, for which province the records are most reliable and exact, the percentage of natives infected with the disease varied from a fraction to as much as 59 (Adjawhe). A larger proportion of cases were found amongst men as com- pared with women and amongst adults as compared with children.

An interesting report showing the increase of the disease amongst the indi- genous population, is the following:-

1. Lawanyo.-October, 1910

July,

2. Towe.-

1911 October, 1908

February, 1910

August, 1911

Percentage of infected.

No. examined.

2,179

.8

2,072

1:54

929

*54

1,181

1.9

1,068

3.75

PUBLIC RECORD OFFICE

Reference :-

mmim C.

885

22 PUBLIC RECORD OFFICE, LONDON

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

The Honourable

the Principal Medical Officer.

SLEEPING SICKNESS IN TOGO.

In 1903 a number of deaths resulting from sleeping sickness were reported in the district of Buemu, in the north-western part of the province of Misahöhe. Two Medical Officers-Drs. Kruger and Hintze-were ordered to proceed there for the purpose of investigating and localising the disease, and the former reported having found a number of cases in Adaklu-the south-western portion of the province- and also further north on the eastern slope of the ridge of mountains which extends from Anum in British territory in a direction north by east into the provinces of Kete Kratchi and Atakpame. These cases were isolated on the grassy and tsetse- free summit of the Hausberg, a hill over 2,000 feet high and distant about three miles from the district headquarters of Misahöhe. These cases all died.

Nothing further was done until 1908, when Dr. von der Hellen, district Medical Officer at Palime, on a tour of inspection through the province discovered a further number of cases suffering from the disease. He collected evidence of its endemicity and comparative frequency and was also able to prove its existence in the neigli- bouring districts.

In view of the extent of the disease, the amount of work entailed in tracing the individual cases and the labour involved in treating them, he suggested the appoint- ment of a Commission to continue the work which he had initiated. His recom- mendations were approved, and towards the end of 1908 a Special Commission was appointed with Dr. Zupitza as senior officer.

Dr. Zupitza has been assisted in his work at various times by Dr. von Raven and Dr. von der Hellen, and this latter officer is now-September, 1913-acting for him during his absence from the Colony on leave.

**

About the same time (end of 1908) a camp was established on the plateau of the Kluto," on the same ridge as the "Hausberg" and distant from it not more than 1-3 mile, but at a slightly lower level and less exposed. This camp has been, until now, the only one of its kind in the Colony, and to it are sent cases from as far north as Sansane-Mangu. Naturally, the province of Misahöhe, in which the Commission has its headquarters, is chiefly benefited, as it is quite impossible to control a larger area with the limited staff at present authorised. It has consequently been suggested to increase the staff to four, and to add to the facilities for treating the infected in the more distant districts in the north.

Within the last three or four years practically the whole Colony as far north as Sansane-Mangu has been visited. Roughly speaking, sleeping sickness is found to occur only in the well-watered and comparatively thickly-wooded western halt of the Colony; the eastern, which is flat and practically all under grass or cultivation, appears free of it. The main focus of the disease is in Misahöhe.

These figures do not support the theories suggested by Drs. Kinghorn and Wade in their reports on the Western Province of Ashanti; Dr. Kinghorn remarks (ride report, 1910) ;--

I am inclined to think that this trypanosome in the course of time has lost much of its virulence by being compelled to pass through a long series of resistant individuals after the susceptible ones had been swept off, and this had gone on to such an extent that it can now only establish itself in these natives with some difficulty."

Dr. Wade states that the disease is found to occur mainly in non-indigenous natives

"The indigenous natives appear to have acquired a degree of immunity."

At the present time only two officers are engaged on sleeping sickness duty. The senior occupies quarters near the camp and is responsible for the management thereof and the treatment of the sick. He has under his immediate orders one European subordinate assistant, two native dressers, a small detachment of police, and a few labourers. Offices and laboratory, the latter fitted with every possible convenience for his work, are adjacent to his quarters.

The junior Medical Officer is engaged in travelling in the province, periodically re-examining patients discharged from medical treatment" under observation," and in collecting new cases, which he sends for treatment to the camp. He is accom- panied by one clerk and an escort of two police. He has the power by law to enforce any form of examination he may consider necessary and to punish if his orders and demands are not complied with. A detailed register is kept of the inhabitants of every village, so that on the occasion of a second or further visit no difficulty is experienced in tracing every man, woman or child. Fortunately for the working of this register there are no villages of any size. The average number of inhabitants was given as 200-300 and rarely exceeding 400. The registration and systematic examination, comparatively easy in such small communities, would be a labour of considerable difficulty when undertaken in the large villages and towns of Ashanti and the Colony of the Gold Coast.

A day or two before the arrival of the Medical Officer in any village, notice is sent to the chief, and he is held responsible for the muster of his people, and has to report the arrival of strangers or any change of domicile. In case of non-compliance, a fine or other punishment can be imposed.

When a suspicious case is discovered, it rests with the Chief to have the patient conducted to the camp. In the case of a stranger, he has the privilege of refusing to do so, and then the patient is taken in charge by one of the escort and immediately

removed.

Every patient admitted to the camp is allowed to bring a friend, who is expected to attend to the cleanliness of the hut, provision of firewood, cooking and purchase of food, and general nursing. A room is allotted to them in one of the huts, and a blanket supplied free to the sick. An allowance of 4-5 pence-varying with market prices --is made to each patient, and one of 24 pence to the attendant. A small market

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