CO885-(23-24) — Page 410

PUBLIC RECORD OFFICE

Reference :-

C.O. 885

23 PUBLIC RECORD OFFICE, LONDON

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

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the tsetse-flies with a view to their control which will, I hope, result from the Report of the Sleeping Sickness Committee now sitting. Whatever may be the case in Uganda and Nyasaland, having regard to the wide distribution of G. palpalis in Sierra Leone I doubt whether any effective measure against sleeping sickness and trypanosome disease of stock can be instituted there except a cam- paign against the tsetse-flies, and the difficulty and cost of such a campaign, at present great, will unquestionably be minimized by the study to which I refer.

I have, &c.,

ARTHUR G. BAGSIIAWE,

10645

No. 5.

GOLD COAST.

TROPICAL DISEASES BUREAU to COLONIAL OFFICE.

(Received 23rd March, 1914.)

Director

[Copy to Imperial Bureau of Entomology, 18th November, 1914. L.F.]

[Answered by No. 7.]

Tropical Diseases Bureau, Imperial Institute, London, S.W. 21st March, 1914. SIR,

I HAVE the honour to acknowledge the receipt of your letter of 2nd March (37977/13), enclosing reports on sleeping sickness in Togoland and the Western Province of Ashanti. I return the map herewith.

two

2. . On page 5 of the printed papers there is a table which purports to show the increase of the disease in successive years amongst the population of localities in Togoland and the comment is made that the figures do not support the theory that the human trypanosome can only establish itself in the natives of Ashanti with difficulty. "It should be pointed out that the figures are small, that there are many factors which might account for the finding of more cases on a second examination, and that, in any case, the results are not necessarily applicable to Ashanti.

3. With respect to Dr. von der Hellen's memorandum on the divergence of action against sleeping sickness in Togoland and the Gold Coast, respectively, it is clear that the measures taken in Togoland are not always suitable to the Gold Coast. As has been frequently stated, "there are many points about sleeping sick- ness in the Gold Coast which would or might render legislation ineffective. Briefly stated, they are these:-The insidious onset of the disease, which may not be recog nized till it has existed for many months, during which the patient is capable of infecting tsetse-flies. The long course, averaging three years or perhaps more. during part of which the native feels well and is able to get about. The impracti- cability of marking infected persons,. as suggested by Dr. von der Hellen.' natives do not pay much regard to the disease, with which they have long been familiar; if regulations are made to which they object, it is perfectly easy for them to conceal cases, as they probably do already. Even with the co-operation of the natives I doubt whether sleeping sickness can be effectively dealt with by gland." puncture diagnosis and subsequent segregation and treatment. and question Of segregation Dr. whether the disease will be thus eradicated in Togoland. Wade writes that a prison instead of a camp would be necessary.

The

4. In view of the facts that in the part of the country most affected the inci dence is only 2 per 1,000, and there is no evidence of an increase of prevalence, I venture to agree with the Governor when he writes that the gravity of the danger is insufficient to warrant the Government in resorting to stringent methods.

5. To turn to Dr. Wade's interesting report. the hypothesis that it is the north country natives who are chiefly infected with trypanosomes and that the pure Ashantis have a large measure of resistance is very important, if it is estab lished. It seems to me to require further support before any scheme of prevention is based upon it. Further inquiries should be set in hand.

6. I think it is important that the Administration should make up its mind whether it is going to insist on clearings being made and maintained by the

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· Transmitting a copy of No. 4 in Miscellaneous No. 275.

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natives and, if so, what is the minimum amount of clearing which it is practi- cable to demand, and that it should then insist on that minimum. Dr. Wade's observations show that the disease in Western Ashanti is found almost entirely in towns on the main roads and adjacent villages. This indicates where clearing should be done. There must be some system of inspection and there can be no doubt that, as the Governor says, the enforcement of clearing regulations should be entrusted to the Administrative staff rather than to Medical Officers. I would sug- gest that there be a sliding scale of extent of clearing dependent upon the size of the village: a large village or town can undertake and maintain a larger clearing than a small village. It is not so much a question of what is desirable as what can main- be reasonably demanded. As Dr. Wade says, if clearings are not to be tained it would be better not to make them.

7. It is disappointing to learn that the new roads, which are, I imagine, essential to the development of the country, are more tsetse-haunted than the bush paths. The running of railways through the endemic area would doubtless tend to prevent infection with sleeping sickness, but can hardly be recommended with- out more cogent reasons.

8. Dr. Wade suggests on page 13 that the Gaman cattle, which thrive under conditions in which imported cattle die, have some measure of protection against the local strains of trypanosomes. It is, I think, very important to ascertain whether these cattle harbour pathogenic trypanosomes and take no harm, like the game, and, if so, to determine the species of trypanosomes harboured.

9. Two important points are raised by these two reports: (a) How is the Gold Const to deal with the sleeping sickness problem? (b) The Anglo-German Agree- ment. (a) This is part of the general problem of sleeping sickness in the British Colonies on this Coast, the Gambia, Sierra Leone, the Gold Coast, and Southern Nigeria. In none of these does sleeping sickness appear to be a serious menace to the well-being of the country; in all the insect carrier is widely spread. The usual methods of combating sleeping sickness are: (1) Measures against the insect car rier, at present practically limited to clearing of vegetation; (2) Removal of healthy persons from the vicinity of fly or their protection from fly bites: (3) Removal of infected persons from fly, ie., segregation in fly-free camps or hospitals and treat ment. (2) and (3) appear impracticable or inadvisable over the greater part of these countries, and we are left with measures against the fly, obviously the most effective of all if they can be carried out.

10. Here we are met by the great difficulty and cost in labour of making and maintaining clearings. We have also to remember that these can only protect or Whenever they travel partially protect natives while they are in their villages.

they are subject to the bites of possibly infective flies. However, there is no doubt that a measure of protection is afforded and I would advocate clearings on the lines of paragraph 6 in those parts of the Gold Coast where sleeping sickness is known to be prevalent, e.g., round towns and villages, especially "zongos" and the water Let these supplies on the trade routes in the Western Province of Ashanti. clearings be made and maintained for, say, three years, at the end of which time it should be possible to form some estimate of their effect. Clearing round villages is a measure of sanitation and, if no difference in the incidence of sleeping sickness is noticed, the labour will not have been lost. Meantime we may hope to have found some simpler method of dealing with tsetse.

11. In this connexion I should like to draw attention to the remarkable reduction of the numbers of G. palpalis produced by clearing in the Island or Principe, testified by consular reports to the Foreign Office. I think it would be instructive if a sanitary officer from one of the West Coast Colonies could he detailed to visit Principe and report on the results.

12. Search for cases should continue, and if segregation is impossible home It has been shown that a single injection of one of treatment should be offered.

the more powerful arsenical drugs keeps the circulation clear of trypanosomes for period measured in months. Careful inquiry should be made into the racial Antecedents of infected natives. for, if Dr. Wade's hypothesis is correct, sleeping sickness measures should have in view chiefly the travelling north country natives. 13. With regard to the Anglo-German Agreement, it would be most unfortu nate if it were to come to an end in consequence of a difference of opinion as to Now that there the value of the measures taken on the two sides of the frontier.

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