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PUBLIC RECORD OFFICE

Reference :-

wmimmimCO.885/25

PUBLIC RECORD OFFICE, LONDON

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

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VIII.--Dr. Hodges's Conclusions.

57. Not until it was certain that it would be impracticable to reach a solution of the local economic problem, as long as extermination of tsetse should remain a condition to be met, was any serious attempt made to follow the line of investigation first suggested nearly two years before by the "Lugazi experiment," which gave the first substantial basis for the statement made in paragraph 13.

58. It was believed that the conclusions which had been reached at Bukakata were original, partly because no one had ever followed the same route before, but more particularly because they were so opposite to the measures for the suppression of sleeping sickness which had been adopted after long and intensive research had, presumably, afforded substantial reason for the action.

59. It was a great surprise, therefore, to discover that they were essentially identical with those which had been reached more than ten years before by Dr. Hodges, as the result of several years' observation and study. His conception of the conditions favourable to epidemics was very different from that upon which the measures for the suppression of sleeping sickness were based, as shown by the following comparison:-

#

60. Conditions necessary for the occurrence of a great epidemic of sleeping

sickness

*

"The presence of Glossina palpalis in large numbers over a considerable

area.

"A thickly gathered, population."

numerous

Free and frequent inter-communi- cation, much of it within the fly range."

A considerable part of the popula- tion either living or daily employed within the fly range."

"

"A coast or banks much broken by inlets, estuaries, and rivers, or with adjacent islands."

Conditions necessary for the occur- rence of sleeping sickness in epidemic form accepted as basis for the measures adopted for its suppression :†

a

"The presence of even a single diseased person, in a locality infested by tsetse flies, may entail the infection of the entire community."

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the tsetse seems to be

the indispensable link in the chain of infection, and it would therefore ap- pear that only by its elimination can the spread of the disease be checked. We should, consequently, either remove all the tsetse flies from the infected areas or else withdraw all infected persons from fly-infested regions."

61. More than a year after Dr. Hodges had first expressed his opinions he reviewed the results of the first half-year's work of the medical officers engaged in the Sleeping Sickness Extended Invstigations, and in the large amount of new data thus rendered available appears to have found no cause to change them. On the contrary, he expresses the same idea in a somewhat different manner by

" and "infective" areas. differentiating between the "infected

62. The former would include the whole area of a large island, for example, the inhabitants of which had occasion to go habitually to the shore of the lake, where they came in contact with large numbers of flies, while the "infective " areas are limited to the narrow belt bordering the lake shore in which the vast majority of the flies is found. They are still further limited to the places of "human concourse within the ordinary "fly range," such as villages or huts which may be located there, canoe landings, watering places, markets, etc., etc. (And it was the manner of the people to pass much of their time in such places.)

"}

69. Dr. Hodges continues by recommending that canoe landings shall be cleared, marketa moved back a few hundred yards from the water, villages, etc., actually located in the fly range evacuated, and that by such methods the "infec- tive areas within which the disease is transmitted from man to man shall be done away with.

"

* From a report by Dr. Hodges upon the occurrence of sleeping sickness in Unyoro and the Nile Valley in 1904-1905. Published in abridged form in the Reports of the Sleeping Sicknes Commission of the Royal Society, No. VII, page 86.

+ From despatch No. 218, of the 23rd November, 1906, from Sir H. Hesketh Bell, His Majesty's Commissioner, Uganda, to the Secretary of State for the Colonies, in which the measures for the suppression of sleeping sickness (involving depopulation of the fly-infested regions) were first formally recommended. (No. 100 in Miscellaneous No. 178.)

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64. These recommendations were made in advance of those for the more radical neasures which were subsequently adopted, and, as far as may be judged from the tenor of such official papers as have been found in the files, they were accorded slight consideration. Fairly careful search has failed to reveal any more cogent reason for this action than is found in the very different conception of the condi- tions necessary for an epidemic to occur and the belief that conditions on the islands, and elsewhere in the infected zone, were not in accord with Dr. Hodges's conclusions.

65. It appears to have occurred to no one to make a thorough examination of the island population and ascertain the facts. Had this been done it is very doubtful if depopulation would have been recommended.

66. At this time, too, there was no particular reason for doubting that the tsetse was well adapted to its role as vector of a human disease. It was believed that it fed on man as freely as on any other host if its chosen haunts were approached, and that it was the vicinity of water, in the first instance, and not the circumstance that its chosen hosts are amphibious, which determined its ordinary dispersion.

IX.-The Demonstration Experiment at Entebbe and its Environs.

67. While engaged in the study of the death returns from different island and mainland sazas, it was noted that in 1907 an extraordinary reduction in the number of deaths by sleeping sickness occurred in the saza of Busiro, which includes Entebbe. In no other saza, and in no other year, had such a remarkable reduction taken place. It was during this year that the depopulation measures were put into effect, but, further study served to convince, no reduction in number of deaths during 1907 could be attributed to this cause. It was in 1908, or one year later, that the general reduction in other sazas took place (except in Chagwe, where, as in the island saza of Buvuma, the epidemic had reached its turning point some years before, and appears to have been declining as fast as it could through natural causes.)

68. The number of deaths returned from the five mainland sazas are shown

in the following table :-

1905

1906 1907

1908

Baza

Your.

Chagwe.

Kyadondo,

Bosiro,

Mawakota.

Baddu.

1,662

412

1,427

395

388

620

399

1,003

440

610

381

223

72

259

230

40

71

74

322 46

69. It was at first supposed that there must be a serious error in the death returns for Busiro for 1907, and a search was made for it. It was not found, but this search disclosed the fact that a full year before the general depopulation measures were put into effect a systematic attempt had been begun to control sleeping sickness in Entebbe, which was recognized to be a "veritable hot-bed" for the disease. Voluminous papers, reports, diagrams, etc., were found dealing with the matter, from which it appeared that the measures designed primarily to protect Entebbe were extended to include adjacent portions of the coast, and that they did include nearly the whole of the coast of Busiro saza, that they were carried out under the more or less direct supervision of Dr. Hodges, that they were framed to accord with his conception of the conditions necessary for an epidemic to occur or to continue, and finally that, barring the presence of a gross error in the com- pilation of the death returns, the figures presented in the preceding table are to be considered as affording a practical demonstration of the efficacy of measures of this character.

70. It is to be regretted that the application of the more comprehensive and radical measures could not have been delayed a few months until the effects of the work done at Entebbe could have been observed.

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