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PUBLIC RECORD OFFICE

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Reference :-

C.O. 885

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

22 PUBLIC RECORD OFFICE, LONDON

not to make them at all.

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clearings once made are not going to be maintained, I believe it would be better There are two reasons to my mind why these clearings are not made, or when made are not maintained by the natives :-

(1) The disease causes no alarm to the native mind.

(2) The natives do not think the Government are serious.

1. A disease occurring sporadically, with a gradual on-set, chronic course, and lingering death is a natural sequence of events, one that to the native mind cannot be prevented; therefore, why should it alarm them! If it were smallpox, or some epidemic which rapidly killed off numbers, they would become alarmed; but with this disease, no especially when it so often happens to be the least important members of the community who are picked out by the disease.

2. Year after year the Medical Officer on sleeping sickness duty goes round this Province telling the chiefs and people to make these clearings, and frequently marking out the 100 yards around their villages for them, only to find on his return each year that nothing has been done. The natives find that no notice is officially taken of their disobedience, therefore, why should they treat the matter seriously!

I shall here recommend what I consider should be the minimum to be done this year: 100 yards clearings around all villages and zongos on the main trade roads and around all bush villages where at present. there are any cases of trypanosomiasis, and that these clearings, when made, be kept properly maintained; 50 yards clearings around the water supplies and washing places of all these villages. When making the clearings, I do not think it necessary to cut down all the trees, but to thin out the forest, and root out all the bush and undergrowth. If any large trees after the thinning out has been completed give too much shade, they could easily be ring- barked. I suggested last year that these clearings might be used for growing sweet potatoes, and, where the soil was suitable, ground-nuts and that any clearings made beyond the 100 yards might be used for yams or corn. The native objection to this was that the cattle and sheep would eat their crops. I suggested fencing in the farms, but to this they did not seem to be agreeable. I now think that if these clearings were planted with dube grass and looked after for a while, they would make an excellent pasturage for sheep and cattle, and would be a much more suitable place to keep them than at present, in their streets and compounds. I do not say that 100 yards clearings are sufficient to keep tse-tse flies out of the villages, but they would at least be a start in the fight direction, and could be gradually increased. I look on these clearings as necessary sanitary measures, and think if any person were to go round the outskirts of as many of these villages as I have done they would agree with me. As regards the 50 yards clearings around water supplies and washing places, what is required here is not the cutting down of trees but the thorough rooting out of the undergrowth and planting of Bahama grass. These measures should certainly be done by the natives living in the villages and zongos, and, if carried out systematically, would not entail an enormous amount of labour. I may say that, apart from Sunyani town and zongo, the natives are very rarely asked to do any sanitary improvements. If the work of seeing to these clearings is to be done by the Medical Officer in Sunyani, then I think it will he necessary to give him some power, especially since this matter of clearing has not been treated seriously for the past three years. This Province, with an area of about 6,000 square miles, is too large to keep constantly going round telling the chiefs and people to clear. I look on the matter in the same light as road clearing, and, as the natives were not educated up to clearing their roads without compulsion, neither will they be educated up to clearing around their villages without similar

measures.

I would suggest that four native overseers should be appointed who could travel about from village to village and mark out these clearings in the different villages and zongos, and report monthly to the Medical Officer at Sunyani what progress is being made. I do not think that these overseers should remain in a village till the clearing is made, as if [they did] they would never get round the Province. In 1910 I sent an intelligent Coast native to a town in this Province to have a clearing made: the natives kept putting off the work from day to day till eventually the overseer got disheartened and took to drink, and finally got into trouble. I don't think it is fair, therefore, to keep these overseers in one place any length of time.

The Medical Officer in Sunvani should be given every opportunity to travel, and for this

purpose should be supplied with carriers, who would be at his disposal when

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he required them. At the present time there appears to be no such supply. In 1911 when I was stationed in Sunyani, I received instructions to proceed round the Pro- vince with the Chief Commissioner; on applying for carriers I was informed that they would not be available for five months, so was therefore compelled to use the labourers in Sunyani Station as carriers. If there is no vote for transport for the Medical Officer, could not some arrangements be made whereby he might be allowed to use the labourers under his control as carriers?

Segregation.-Segregation of the infected persons in the Province, would be an excellent prophylactic measure if it could possibly be carried out, but I believe it would be impracticable here. Even if the infected residents of the Province were segregated, which could only be done by using strong measures, there would always be the floating population travelling in and out of the Province, among whom are many trypanosome carriers, and who, I believe, constitute the greatest danger.

Roads.-The new roads which are at present being made through the forest, though they are a great improvement as regards transport, to my mind are more dangerous as regards trypanosomiasis. Moving objects seem to be a much greater attraction for tsetse flies on these broad sunlit roads than on the dark ones. On each side of these roads where the forest has been cleared back for a few yards there is now a tangled mass of moisture-laden vegetation, shaded by the branching trees, and forming an ideal habitat for tsetse flies. As the sides of these roads cannot be kept cleared, I think the best thing is to encourage undergrowth to grow as high as possible, and so shut off the roads from the forest. The first great prophylactic measure which the Government has taken against trypanosomiasis in Ashanti was the prohibition of the importation of north country slaves into the country; north country natives are now coming into the country in much greater numbers not as slaves, but as free people doing the transport work of the country, and I believe the next radical measure which would prove of greatest use would be the driving of these north country carriers out of the endemic area. The only legiti- mate way, as far as I can see that this can be done, is by competing with them in their trade, and that can be accomplished by building railways. If railways could be run through the endemic areas where north country natives are employed in large numbers, I think there would quickly be a diminution in the north country popu lation, and also in the incidence of this disease; but until some such measure as this is undertaken, I believe trypanosomiasis in this Province will remain, as at present, in a state of equilibrium.

It has been suggested that the north country natives bring the disease down with them into Ashanti. It would serve a useful purpose if it could be definitely settled whether or not trypanosomiasis occurs amongst the natives of the Northern Territories who have never left their district. As a number of Moshis are found infected in Ashanti, similar information from the French authorities would be valuable.

Laboratory-Useful experiments could be carried out in a well-equipped labora- tory by a specially qualified Protozoologist, and if the Government considered such a proposal, plenty of material for working on could be obtained in Coomassie, which would be a most convenient place.

Treatment. Under this heading I have very little to say. The native method of treatment which is applied to all enlarged glands, no matter from what cause, consists in scarifying the glands and applying some irritating substance, which gene- rally causes the enlarged glands to slough away. I have had an opportunity of examining a few of the people who had submitted to native treatment for trypano- somiasis, and whenever I succeeded in getting gland juice I found trypanosomes. Instead of this treatment doing good, in my opinion, it only destroys one of nature's lines of defence against the invading trypanosome. This treatment causes the enlarged glands to disappear, and so for a time raises the patient's hopes.

As far as atoxyl treatment is concerned, I believe if the people ínfected could be got to attend the hospital in Sunyani a lot of good could be done. I don't think Sunyani by any means a suitable place to bring a number of infected persons into, but it is the only station in the Province in which a Medical Officer resides, and so the only place where treatment can be given. I took a considerable amount of trouble in trying to get the infected ones to come to Sunyani, and gave each a letter to the Medical Officer; so far, only ten arrived at the hospital, and of these only two or three attended for a short time. One reason, I think, [which] keeps some away is the fear of running into debt. Sunyani is by no means a cheap place for strangers to live

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in, and the guardians of the infected ones are unwilling to undertake the trouble and expense of bringing them in and keeping them here for a course of treatment. I would suggest that the infected persons who come to Sunyani and remain for treatment be granted subsistence at the rate of, say, two shillings a week, to be paid to them if they attend hospital regularly. The expense would not be great, as for some time few would take advantage of the offer,

*

A segregation camp where the infected persons could be kept together would simplify matters considerably as regards treatment, but I am afraid it would be impossible to keep people in the early stages of the disease in it. A prison instead of a camp would be necessary, and unless the Government are prepared to use force the result would be an expensive failure.

Of the twelve people who received atoxyl treatment here in 1910 five (north country natives) are alive and fit at present; four others were fit up to the end of 1911, but have since been lost sight of, and three who were in a late stage of the disease when first discovered have died. I enclose with this report full statistics of all cases of the disease found since these investigations started in this Province in 1910. I also enclose two maps, one giving the towns and villages visited, with the number of cases of the disease found in each since 1910, and the other giving the distribution of tsetse flies in the Province.

W. M. WADE,

Sunyani, Western Province, Ashanti.

25th June, 1913.