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PUBLIC RECORD OFFICE

Reference :-

C.O.885/25

PUBLIC RECORD OFFICE, LONDON

ALLY WITHOUT PERMISSION OF THE BE REPRODUCED PHOTOGRAPHIC-

COPYRIGHT PHOTOGRAPH-NOT TO

In

from each instance, and

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available

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the best figures which are appears that, with a few exceptions, the number of deaths, and, conse quently, the number of new infections, decreased more (and generally much more rapidly than the number of "possible victims" (if the term be construed to mean the residents of communities located in fly-infected regions, as is implied by the course of reasoning in paragraph 24).

64. When the probable or possible exceptions to this rule are scrutinized every one of them is found to be associated with the unusual movements of natives induced by depopulation measures, or else [as in the one conspicuous case of the death returns from Kyadondo and Busiro (Table V.)] to be associated with obviously inaccurate figures as far as their reflecting the true situation is con- cerned. The effects of climatic conditions-local famine, varying abundance of tsetse from year to year, and other factors-which might, and probably did, affect the course of the epidemic to some extent are thus discounted, as compared with the one constant factor-decreased density of population in each affected district in turn, and particularly of that portion of each local population which was more particularly, by its mode of life, thrown into contact with Glossina.

65. The coming of a single infected person to a community living in contact with tsetse fly might, under circumstances very favourable to transmission of discase, result in the infection of the entire population-doubtless it did in some cases, but the actual facts indicate very conclusively that a so deplorable outcome 18 impossible unless the human population is very dense or the region is heavily infested by tsetse, or both.

66. This fact in the epidemiology of sleeping sickness was not so plainly apparent in 1906 as it afterwards became, and failure to recognize it made the situation out to be vastly more serious than it really was.

67.

The Situation which has resulted.

The situation which has resulted is peculiar in many ways. In 1908 and 1909 it was represented to the chiefs that the situation was very serious, and that "all the people would die" unless the infected zones were depopulated.

68. Inspired by these fears the chiefs, "whose opposition to the wishes of the Government might, perhaps, have proved almost insuperable" loyally co-operated in carrying out the measures, even at great pecuniary loss to themselves. It was clearly understood that the move was 'for their own good and the good of the country."

69. It was also represented to the chiefs that "their tenants would not be irretrievably dispersed," and that "as soon as the islands are considered to be absolutely safe of infection by sleeping sickness" they would be allowed to return. No time limit was set, but the preliminary arrangements had been conducted ou the clear understanding that exile was to last for from one to three years. It was never proposed that the districts should be tabu for ever, and the subject was never mentioned except to disavow any such intention. Except for this understanding it is probable that the strong influence of the chiefs would have been exerted against, instead of in favour of, the measure, and force would have been required in Uganda, as it would have been in East Africa, if depopulation had been carried

out there.

70. From one point of view the measures have succeeded to meet the most sanguine hopes of their sponsors for sleeping sickness has been practically extir- pated from Buganda or wherever else the measures were thoroughly carried out. But even though it were possible to state with positive assurance that the last trace of infection had disappeared with the two victims whose deaths have been returned in 1915, and that every fly on the lake shore and islands had been rendered as innocuous as at any time prior to the epidemic, the Government would be unable to make good the representations which were made to, and which secured the active co-operation of, the natives so that, from the broader point of view, the measures may be said to have failed.

71. Failure may be considered as partly due to the unforeseen circumstances that a trypanosome indistinguishable (by laboratory methods) from Trypanosoma gambiense persists in fly and game. But it is equally due to a similarly unfore seen fact, that the populations of neighbouring infected districts where similar measures were not carried into effect did not all die, as was foretold would be the case, but have lived, and measurably have flourished, with the result that what appear to be permanent endemic centres have come into existence

of what is

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The

undoubtedly the human disease, apparently in all its original virulence. near neighbourhood of such endemic centres, in the Eastern Province of Uganda Protectorate, in British East Africa, and probably, or possibly, in German East Africa, the Congo, and the Sudan, coupled with the increasing ease and facility of intercommunication, would make repopulation of the Buganda lake shore and islands, under the terms originally proposed, hardly, if any, less dangerous (and perhaps even more dangerous) than its continued occupation would have been.

The natives of 72. Success and failure are thus strangely intermingled. Buganda were asked to make a supreme sacrifice, and have done all that was asked of them. Notwithstanding this, they appear to be no nearer their goal than before, and in large part for this curious reason. Being told that all who remained would die, they fled. But their neighbours who chose to remain did not all die, in consequence of which those who fled may not return.

73. It is as has happened in smaller affairs in which the owner of an estate goes to great pains and expense to exterminate some pest and finds his labour largely lost The logical course of because all his neighbours do not take similar measures. action in the two cases is also the same; if the neighbours cannot see their way clearly to co-operate to the necessary extent, nothing remains but to repudiate the policy of extermination in favour of one more in keeping with the exigencies of the situation or permanently to evacuate the lands involved.

Conclusions.

I.*

74. Conditions in Buvuma and Sesse, as well as in other parts of the infected zone, were plainly unfavourable to further increase and wider dispersion of Try- panosoma gambiense as a parasite of man, and any questions concerning the identity of the "fly strains," antelope strains," and "human strains" of this parasite cannot materially modify this conclusion.

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Consequently deaths by sleeping sickness would certainly have continued to decrease in number until a still lower level was reached or more favourable conditions supervened to make for increased number of infections.

Hence the promulgation of regulations which would merely have established the existing conditions on a permanent basis would have prevented the death-rate ever rising and have made the lowest level reached about the maximum which could be expected.

II.

75. From all that can be learned of the conditions existing in the infected zone at the time when the epidemic was naturally declining, the simple regulations suggested by study of existing conditions in the Bukakata District would have met, and would still serve to meet, the requirements of the case.

EXCERPTS 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.†

18. Scheme for Extended Investigation.-Reports received from Usoga and other parts of the Protectorate during 1905 indicated that sleeping sickness appeared to be rapidly spreading inland, and it became evident that more extensive researches were urgently needed. On the recommendation of the Royal Society a scheme for an extended investigation was adopted, and six Medical Officers were specially appointed in this connexion. Dr. Hodges, who had already been much

It is, of course, an alternative to the conclusion reached in I., that the survivors on the islands, sto., were relatively immune to infection. There seems to be a fair amount of data bearing upon this point, and, so far al it goes, it appears to afford no basis for any such theory- although there appears to be some slight grounds for one to the effect that the strain now persisting in flies and game on the islands and elsewhere is less virulent than the former buman strain.

+ No. 100 in Miscellaneous No. 178

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