PUBLIC RECORD OFFICE
mwimmi
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Reference :-
23 PUBLIC RECORD OFFICE, LONDON
ALLY WITHOUT PERMISSION OF THE BE REPRODUCED PHOTOGRAPHIC- COPYRIGHT PHOTOGRAPH-NOT TO
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Population, Pursuits, and Roads. The population of the Northern Province, according to the census of 1911, amounted to 35,962; it was distributed as follows:
Kintampo District
N'koranza District
Banda District
2,809
13,271
4,582
5,932
6,734
2,634
27
This gives a percentage of 0.18 for the whole of the Province. Distributed according to Districts of the Province, as shown in the table below, it will be noticed that there are marked differences in the number of infected persons in the different Districts.
Mo District
Attabubu District
British Krachi
The chief pursuits of the inhabitants are agriculture and weaving. In the Banda District a certain amount of cattle rearing is undertaken, but it is entirely con- fined to the neighbourhood of Banda, which is apparently free from tsetse fly. A small amount of cocoa is grown in the N'koranza District, and a little rubber is also collected from this part of the Province. The Northern Province is not a producer of valuable articles of commerce, e.g., rubber and kola nuts, like the neighbouring Western Province. Possibly, as the collection of rubber and kola nut farming entail work in the haunts of G. palpalis, this is one of the reasons why the incidence of human trypanosomiasis is greater in the Western than in the Northern Province. A little fishing is done by the natives living near the larger rivers.
The two main roads from Coomassie to the east and west sides of the Northern Territories traverse the Province. A road runs from Kintampo to Attabubu, via Abease, and is continued eastwards to British Krachi. There is a road-only practicable in the dry season-from Kintampo to Banda, via Lawra. A good road leads from Bwe ferry on the Black Volta to Banda, where it forks, one branch going to Bontuku and the other to Mengi, via Sabyia. The old military road to Gam- baga runs from Kintampo through Dawa and Porta. Following the telegraph line there is a road from N'koranza to Attabubu, and a road exists which leads from Jema to Takiman, thence to Coomassie. In addition to these roads there are innumerable "bush" paths, passing between adjacent villages. There is consider- able traffic in cattle and kola nuts on the two main roads, and the natives bringing cattle down from the Moshi country frequently diverge from the main road at Jughey and across the Black Volta at Bangbey, following a road (not shown on Cattle traders, the Government maps) through Weile to Wenchi and Coomassie. owing to their habit of lingering on the roads in the neighbourhood of fly-infested streams. may, if infected themselves with trypanosomiasis, spread the disease along the roads they traverse. Zongos in this country are noted for a higher percentage of cases than villages adjacent to them.
History of the disease amongst the inhabitants.-The natives of the Province recognize the disease in its advanced stages, but can give no definite history of its duration. They do not consider that it is spreading; and, while they know that the disease is almost invariably fatal, they are not afraid of it.
They do not appreciate the rôle played by the tsetse fly in its causation, and they are incapable of recognizing the disease in its earlier stages, as might be expected, enlarged cervical glands being the result of the presence of other para sites, as well as of T. gambiense. Kinghorn, in his report of his tour in the Banda District, has pointed out that the inhabitants of that part, except those who have travelled beyond its boundaries, profess entire ignorance of the disease. Method of examination of the natives.-So far as possible the inhabitants were examined in the evening after they had returned from work on their farms. Unfortunately many villages met with en route had to be examined as one was passing through during the day, when many of the adults had left to do their day's work. Palpation for enlarged cervical glands, puncture of these when sufficiently large to admit of puncture with a hypodermic needle, and examination of the fluid so obtained, was the principal method employed for isolating cases of the disease. Occasionally, when the glands were found to be too small to admit of puncture, examination of blood films was resorted to.
Number of people examined and number of cases found. In all 18,767 people In arriving at were examined and 34 cases of human trypanosomiasis were found. the number 34, I wish to explain that I have added to the actual number of 30 cases seen by me while on tour two cases of the disease which occurred in Kintampo during the early part of the year (both had died before the routine examination was made), one case discovered by Dr. Wade in Kintampo in Septem- ber, and one case, that of a river policeman at Krachi, treated at Coomassie during August and September.
Mo
Kintampo
N'koranza
Banda Krachi Attabubu
District.
Number Examined.
Number of Cases Found.
Per cent.
2,192
15
0.64
7,870
5
0.00
2,140
B
0.14
2,091
4
0.14
985 8,489
5 2
0-58
0.05
Apparently there are two centres of infection in the Province, Kintampo and Krachi. I stated in my monthly report for September that probably Mo and Banda districts would prove the least infected; in this I was wrong; the least infected parts are N'koranza and Attabubu. These districts have stretches of dense forest in which G. palpalis is to be found, but this fly is not so plentiful in the monsoon type of forest as it is in the forest met with along the banks of the rivers in the more northerly parts of the Province. This I believe to be the explanation of the inhabitants of the southern districts enjoying comparative freedom from the disease.
Concerning the sex and age of persons infected with trypanosomiasis.—In an article published in the Annals of Tropical Medicine and Parasitology, Volume VII., No. 2, page 309, Todd gives an analysis of 79 cases of trypanoso- miasis seen among natives of the Gambia.
In recording the number of people examined in the tour of the Northern Province, my clerk was instructed to enter individuals in accordance with the scheme employed by Todd, grouping them by sex under the headings, under 15, over 15, and over 45. The tables below give the result:—
Mules Females
NUMBER EXAMINED AND PERCENTAGE OF TOTAL EXAMINED.
Under 13.
8,690-19-6% 8,858=20-5%%%
Over 15.
4,702=25%
5,697 = 90·9%
Over 45.
841-1·8%% 484-2.5°
NUMBER OF PERSONS INFECTED AND PERCENTAGE INFECTED OF NUMBER EXAMINED.
Malen Females
Mules
Females
Under 15.
2=0·05% 1=0·02%
Over 15.
20-0-42% *10=0·14%
PERCENTAGE OF CASES INFECTED UNDER EACH AGE LIMIT.
Under 15.
5·8% 2·9%.
Over 15.
58.8° 29-1%
Over 45.
1=0-29% 0=0%
Over 45.
2.9% 0%
Todd's conclusions are (1) that the proportion of elderly individuals is much lower amongst the natives of the Gambia than it is amongst Europeans; (2) that the majority of cases of trypanosomiasis are persons of middle age; almost none of them are elderly persons; (3) that the low incidence of trypanosomiasis among elderly people may be due in part to an immunity acquired by them. The tables shown above certainly seem to confirm the first two of these conclusions: the number of elderly people seen bears a considerable less proportion to the total examined than in the Gambia, where 7-3 per cent. were males, and 54 per cent. were females.
Page 420Page 421
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Glandular enlargement. The presence of glandular enlargement, especially of the posterior cervical glands where there is no obvious cause for the enlargement, such as pediculosis, seborrhoea of the scalp, otitis media, cutaneous abscesses, alveolar abscesses, yaws, etc., is suggestive in Tropical Africa of trypanosomiasis, and calls for further investigation. After a little experience of palpation the swollen glands, which are likely to yield trypanosomes on puncture, are readily recognized. They have been so frequently described that it is not necessary to attempt to do so afresh. Filariasis occasionally produces a chain of symmetrically enlarged glands, which, in their consistency, resemble the typical enlargement due to trypanosomes. Puncture and examination of the fluid has on two occasions revealed filaria when I expected to find trypanosomes.
A single hard inelastic gland situated beneath the sterno mastoid at about It was more the level of the cricoid cartilage, was frequently met with in adults. often left-sided than right, and was more often found in males than in females. What its exact significance is I am unable to say, though I incline to the belief that it is due to nasal or pharyngeal irritation. It bears no resemblance to the resilient glands associated with trypanosomiasis. The results of gland palpation are tabulated in accordance with the classification of Dutton and Todd, though I
section am doubtful of the correctness of the grouping in the +
Number Palpated.
18,765
+ Glands.
+-Glands.
35=0·18
69 -0.98%.
+--Glands.
Normal.
2,824-15-04%
15,848 84-48",
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Kintampo itself is peculiarly placed as regards the disease. Not only is it a halting place for traders travelling between Coomassie and the Northern Terri- tories, but it is so situated naturally, being enclosed upon three sides by streams, which, though small, are permanent, as to be in the centre of an area infested with G. palpalis. A considerable amount of clearing has been done along one of the streams which is now almost free from fly, but much remains to be done, especially in the vicinity of one of the native water supplies. Krachi, situated on the Volta, in the angle where the Beresu joins that river, is also much infested with tsetse fly. There is a well cleared area around the preventive station, but in the rainy season elephant grass is allowed to grow close up to the outskirts of the native village. Elephant grass is capable of affording the shade required by G. palpalis, and should not be permitted to grow in such close proximity to a village which has been known to be infected for some years past.
The following lists give the names of the villages visited, the number of people palpated in each village and the number of cases of trypanosomiasis found. The villages are grouped according to districts, but I wish to point out that, as there is no record obtainable in the Commissioner's Office of the villages belonging to each district, I am responsible for the arrangement, and very probably villages are included in one district which belong to another.
I. Kintampo.
Estimated population at Census of 1911.-2,809.
-Kintampo town
1,794 people seen
I Company, G.C.R.
Glands are more commonly enlarged in the male sex, this is shown below:-
Males Females
+ Glands.
24-68%. 11=81%
+-Glands.
48=76%
15=28
+--Glands.
1,698-59.9% 1,131=400%
Of 35 people showing "+" glands, 34 were punctured-one did not appear -" glands, 57 for puncture and 27 were infected. Of 63 people showing “+
were punctured and 5 were infected with trypanosomes.
"
glands, 22 were punctured; none of these Of 2,824 persons showing showed trypanosomes. This is tabulated below. Wade's case and the case of the river policeman are not included in this table.
+ Glands
+- Glanda +--
Glands
Number.
Number Punctured.
Per cent. Infected of those Punctured.
85
91
68
57
2,824
22
79.4%
8-7% 0%
10 cases found
141
do.
2
do.
Lines of I Company
84
do.
1 case found
Small Kintampo
42
do.
1
do.
Cherimankoma
66
do.
0
do.
Zongo on
road
Coomassie
65
do.
1
do.
Total
2,192 people seen
15 cases found
II. N'koranza.
Estimated population at Census of 1911.-13,271.
Jema
132 people seen
No case found
Kukuma
98
do.
Abodóm
95
do.
do.
do.
Yefri
250
do.
1 case found
Prinihin
198
do.
No case found
N'koranza
340
do.
do.
N'koranza Sassima
156
do.
do.
N'koranza Kissima
327
do.
do.
N'koranza Zongo
8
do.
do.
Tadieso
90
do.
do.
Abo N'tum
124
do.
do.
N'kwanta Akoma Buraboho
151
do.
do.
187
do.
I case found
139
do.
No case found
N'kwabeng
258
do.
do.
Kwasse
54
do.
1 case found
Odumase I.
247
do.
No case found
Bonsu
121
Dortobeng
146
Odumase II.
88
Akonkonti
25
490
Akrudjuah I.
50
Akrudjuah II.
159
Boabeng
89
Fiamah
197
Bonti
121
Bomiri
213
Norsi
57
Domiabra
100
Tankor
141
Boama
155
Sika Kuma
145
8888888888888888
do.
do.
do.
do.
do.
do.
do.
do.
do.
do.
do.
do.
do.
do.
do.
'do.
do.
1 case found
do.
No case found
do.
1 case found
do.
No case found
do.
do.
do.
do.
do.
ggg
do.
do.
do.
Distribution of cases of human trypanosomiasis throughout the Province.— As has been already stated, there appear to be two foci of the disease, namely, were discovered in Kintampo and its Kintampo and Krachi. Thirteen cases immediate neighbourhood, and two more within a radius of six miles from the town. Four cases were found at Krachi (Nsumia) and one at a small village about four miles from Krachi. Two cases were seen in the Zongo at Attabubu; one of these was a man travelling down from the Northern Territories. I wish again to point out that Zongos are, in this country, frequently infected, the disease having very probably been acquired on the banks of streams long distances away from the place where it is found. The places where trypanosomiasis was detected are indi- The majority of these will be cated by black squares on the accompanying map.* seen to lie upon or within easy distance of rivers; others not so situated are upon main traffic routes, e.g., Attabubu Zongo, the two Zongos near Kintampo, Yefri.
Bosobiah
*Not reproduced.
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