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PUBLIC RECORD OFFICE, LONDON

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2. A. The history of the various epidemics of this disease show that it spreads but comparatively slowly from an infected area, but may be carried with great ease by infected persons to localities where it did not previously exist.

In the Congo Free State it is, for example, along the main trade routes that the disease has extended. On the map circles indicate a few of the posts, in uninfected districts, at which imported cases of "sleeping sickness" have been observed. All of these patients were soldiers, labourers, or their wives brought long distances from their homes, as a direct result of the opening up of the country by Arabs and Europeans.

B. The extension of human trypanosomiasis may therefore be checked by pre- venting infected persons from entering districts where the disease does not occur.

C. It has been shown that:-

(a) In apparently healthy negroes in the earliest stages of human trypano- somiasis the presence of the causative parasite, Trypanosome gambiense, may be detected by the palpation and puncture of the lymphatic glands.

(b) In practice every negro whose neck glands are enlarged without obvious cause must be considered to be a case of trypanosomiasis until the contrary is proved.

Therefore, good results may be expected from the serious application of quarantine measures, dependent for their efficiency upon cervical gland palpation.

3. The measures recommended are briefly:

(a) The establishment of medical posts of inspection along the trade routes

leading from infected to uninfected districts.

(b) The removal of infected persons from posts in uninfected districts to

places already infected.

If success is to be obtained the application of these measures must be thorough. The details of the way in which they are to be made effective cannot be considered here. They must be left to those who are to administer them. It may be suggested, however, that in most instances it will be impossible for the existing Medical Officers to enforce such measures in addition to performing their ordinary duties. situation is quite serious enough to require the whole attention of special medical officers, aided by competent staffs.

The

4. As an example of the applicability of the proposed measures, consider the case of Nyassaland.

It is certain (see map) that the natives of the southern as well as of the northern shores of Lake Tanganyika will shortly be very heavily infected with trypanosomiasis.

Labourers are engaged from the neighbourhood of Lake Tanganyika to work in Nyassaland. There is constant communication between these two districts; since one of the most important caravan routes to Central Africa runs between Lake Nyassa and Lake Tanganyika. In our opinion, therefore, it is only a question of months before imported cases of the disease will be reported from Nyassaland.

It is evident that the communication between these two areas should be stringently controlled.

Posts of inspection should be established to prevent infected porters, in caravans, or labourers, from entering British territory. Every employer of labour must be made to understand the danger of enlarged neck glands and instructed to send negroes possessing them to the nearest post of inspection. Each person residing or travelling in uninfected areas must be made personally responsible for the presence of persons with enlarged glands in his following.

5. It is believed that the difficulties of applying these measures will not be as great as might be anticipated.

Natives will soon learn, and appreciate, the danger of enlarged glands. They have long recognised their significance in Sierra Leone and Uganda.

It will admittedly be impossible to altogether control the movements of indi- viduals; but it is not from single persons, as a rule travelling only a few miles, that danger is to be apprehended. It is the organised transport of

groups of which is dangerous.

negroes

28624

SIR,

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No. 61.

LOCAL GOVERNMENT BOARD to COLONIAL OFFICE.

(Received August 4, 1906.)

[Answered by No. 67.]

Whitehall, S.W., August 3, 1906. I AM directed by the Local Government Board to advert to your letter of the 16th June last (No. 21128/1906)* enclosing copy of "Reports of the Expedition to the Congo, 1903-1905," Memoir XVIII. of the Liverpool School of Tropical Medicine; and in compliance with the request contained in your letter of the 12th May last, I am to forward to you to be laid before the Earl of Elgin the enclosed copy of a memorandum by the Board's Principal Medical Officer

I am, &c.,

H. C. MONRO,

Assistant Secretary.

Enclosure in No. 61.

MEDICAL OFFICER'S MEMORANDUM.

For 50 years or more " sleeping sickness," or malady or maladies now reputed to have been of that nature, has existed in countries bordering the Lower Congo. Elsewhere in the Congo region of the African Continent disease of this class, if it has occurred, does not appear to have been recognised prior to 1885-90. Within the last 20 years, however, and in sequence to opening up of the Congo country by Europeans, "sleeping sickness" has become well known and widespread. Especially has such disease, since the opening of a trade route from west to east on the African Continent, affected countries bordering that trade route throughout its extent, inclusive of regions in the neighbourhood of the great lakes; and later still, since the Congo itself was adopted as the principal trade route, it has affected countries bordering that waterway.

In explanation of the above facts Drs. Todd and Dutton advance the proposi- tion that a disease heretofore indigenous to, and endemic in, districts about the mouth of the Congo has, as a result of the inter-communication of peoples brought about by new trade conditions, been disseminated far and wide and mainly by human agency; the human agent being, not the incoming European, but the native journeying on white man's business, and, while so passing from place to place, suffering, lightly or otherwise, under a parasitic malady, trypanosomiasis.

Upon the basis of this proposition Drs. Todd and Dutton recommend certain measures, the adoption of which will, they consider, secure control of "sleeping sickness."

Trypanosomiasis is regarded by these reporters as "sleeping sickness"; a phase of this malady which may, it appears, last in the an ambulant stage of individual for a period measured by months and even years, a period, indeed, during which he may travel to and fro many hundreds of miles. Further, there would seem to be tacit assumption on the part of the reporters that no animal other than man serves as host of the particular trypanosome that is in question. It is restriction, therefore, of the liberty of the native who happens to be the subject of trypanoso- miasis that is the essence of the measures these observers recommend for adoption. They are not concerned with the agent which transfers the trypanosome from to person. Whether this be glossina palpalis or some other fly or flies matters person nothing to the thesis they are propounding. So long as persons harbouring the trypanosome in their blood are absent from a given district the flies there cannot, in Drs. Todd and Dutton's view, transmit the disease.

Under a scheme of controlling sleeping sickness by restriction of transit about the country of natives the subjects of trypanosomiasis prompt identification of this affection becomes all important. As to this, Drs. Todd and Dutton claim, as a result of their earlier observations, to have made prompt identification of the malady easy. They say "that the great majority of cases of enlarged cervical glands in apparently healthy negroes examined by us, mean trypanosomiasis”; and they intimate that

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† No. 53

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