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PUBLIC RECORD OFFICE

Reference :-

C.O. 885

9 PUBLIC RECORD OFFICE, LONDON ALLY WITHOUT PERMISSION OF THE

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present moment seems a particularly favourable one for carrying energetic measures into effect.

33. The authorized provision, in the estimates for the current year, for special estimate of expenditure in connection with sleeping sickness amounts to £5,180. The measures which are now being proposed will considerably affect the existing arrangements. The six temporary medical officers, now employed in "Investigation," will be placed in charge of camps, but it will still be possible for them to pursue certain studies in the neighbourhood of their stations. On the existing scale the estimated expen- diture, during the three years to come, would amount to about £15,500. The pro- posals now being made will cost about £25,000 during the same period, so that the Treasury will only be asked to provide an additional amount of £9,500 spread over three years. I may add that I count on being able to reduce the expenditure on the general medical service of the Protectorate by about £1,500 a year.

Establish. ment of

camps.

34. I propose to establish camps wherein all persons suffering from sleeping sickness shall be interned. These camps will be of convenient size, so that they can segregation be managed by a comparatively small staff and in order that the supply of food may not be a difficulty. Doctor Hodges considers that nine of them will be required, and recommends that they should be established in the hinterland of each príncipal centre of infection. Four camps will be required in Uganda Proper, one in Usoga, one in Unyoro, one in the Nile Province, and one in the centre of the island of Buvuma. These camps will be located in districts that are absolutely free from fly, and will be of sufficient extent to provide all the land necessary for banana gardens, potato fields and other cultivations necessary for the maintenance of the sick. The chiefs will be required to allow the Government the free use of these lands, for such period as they may be wanted for the purpose intended, but reason- able compensation will be given to peasants who may have to be turned out of their huts and gardens.

Classifica. tion of inmates.

Scheme of segregation camps.

35. The inmates of the sleeping sickness settlements would be divided into two classes: (1) Sick persons unaccompanied by healthy relatives; and (2) Sick persons accompanied by a reasonable number of members of their family, who would live with them and grow food for their support. Food and lodging for those in the first category would have to be provided by the Government until sufficient supplies could be grown in the settlement. These destitute sick would be housed in large thatched sheds, similar to those used in the White Fathers' Mission Hospital at Kisubi. It is estimated that the food of each patient in this category will cost about one rupee (1s. 4d.) a month, but clothing, medicine, and nursing will also have to be paid for.

36. As regards the people in the second category, the cost to the Government would be very small. A husband would be accompanied by his wife, a mother by one or more of her children, and so forth. These small families will be located on suitable spots and they will build their own huts and make their own gardens. The sick persons and relatives will live in the settlement much as they did in their own villages, but the diseased persons will not, on any pretext, be allowed to leave it. The relatives will be permitted to do so, occasionally, on being provided with "Passes." These passes would be issued by the Medical Officer in Charge and only on his being satisfied that the people were perfectly free from sleeping sickness. Save for special reasons, only the infected and their relatives will be allowed to enter the settlement, and the roads leading to the camp would be patrolled to prevent the infraction of that rule. The Medical Officer in Charge would hold parades of all the inmates of the camp at regular intervals, and would render weekly reports of all arrivals and deaths, together with such other information as might be required. 37. All persons residing in the settlements, who would be living with and working for a sick relative, would be exempt from all taxes. This proviso is intended to attract relatives of patients to the settlements, and so reduce the cost to the Government of providing food.

38. The Medical Officer in Charge will provide medicine for the sick and will otherwise treat them clinically. He will not, however, save in exceptional cases, perform post mortems or do anything which might make the natives dread going into the settlement. This is a concession to the notions that are prevalent among the natives as to the gruesome nature of the work that was done in the sleeping sickness laboratory at Entebbe. They are convinced that sleeping sickness was

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'manufactured" by the experts in the laboratory, and that the bodies of the dead were opened for some fell purpose of the white man!

39. Doctor Hodges recommends that treatment by "Atoxyl" should be tried Treatment on an extensive scale in the camps. On this subject he says in a minute to the by atoxyl. Deputy Commissioner:-

•

Whatever may be the ultimate result as regards cure, it is certain that pre- parations of arsenic are beneficial and often lengthen life in human trypanosomiasis besides lessening the risk of infection by banishing the trypanosome from the glands and peripheral circulation, so that such cases for the time being cannot infect the fly and cease to be a danger to the community. It is a fact also that atoxyl is a less poisonous preparation of arsenic than any hitherto known and can, for this reason, be given in large quantities, is safe and suitable for hypodermic administra- tion and is far more applicable for general distribution among the thousands of sick natives with whom we have to deal than any drug which was previously been proposed as a cure. I consider, therefore, that not only is it justifiable to incur considerable expenditure in giving it an extensive trial as a curative agent, but that the measures undertaken for this end may be so ordered as to assist materially in carrying out the most important general preventive measure which is at present open to us, namely, segregation of the sick, which His Excellency has now in con- templation." A considerable supply of atoxyl was ordered some weeks ago and is expected to arrive shortly.

40. Doctor Hodges states that, in order to place all the sleeping sickness settle- Medical ments in proper working order, an increase of at least five temporary medical officers staff will be necessary,

and in this connection he says: "This work, if undertaken, should required. be commenced as soon as possible and carried on without break or hindrance, and as three of the medical officers at present engaged in the sleeping sickness extended investigations will be due for six months' leave in April and May next, I consider it necessary that the services of these extra medical officers should be available in Uganda by April, 1907, at the latest."

41. I do not propose to establish all the nine camps simultaneously, but to open them seriatim, and thus to profit by the experience which we shall gradually gain in organizing the settlements. All buildings will be of a temporary nature, and everything will be done as economically as possible. In view of the urgency of this matter and the willingness now being evinced by the native chiefs to help in carrying out these measures, I have ventured, in one instance, to anticipate your Lordship's approval of my recommendations, and we have already started with the segregation camp for Busiro. Doctor Wiggins, of the Sleeping Sickness Extended Investigation, Measures has been placed in charge of it, the buildings are ready for the reception of destitute actually in patients, and, in a few days, we hope to have everything in working order. A minor progress. chief is being placed in charge of the Camp, and it will be business to see that

an adequate amount of food is forthcoming at reasonable rates. As soon as the Busiro Camp shall have been properly organized, we propose to proceed with the one required for Unyoro. The third would be in Usoga, and I hope that, subject to your Lordship's approval of these measures, all the settlements will be in proper order before the middle of next year.

42. Your Lordship will note that I advocate, not only the removal from the lake shore of all sick persons, but also of all those who, so far, appear to be free from the disease. I do so because the period during which flies are capable of retaining the power of infection is still open to doubt, and also because it would be very difficult, short of absolute removal, to prevent healthy natives from frequenting the borders of the lake where they might be bitten by flies infected in the Sesse Islands or elsewhere. I do not propose that the districts adjoining the Victoria Nyanza Depopula- should be tabu for ever, but merely that they should be cleared of population for tion of ty- a year or two, so that by removing from tsetse flies the possibility of procuring belt. infection they may ultimately become as innocuous as they appeared to be prior to 1901.

infested

43. All the land, in the Uganda Kingdom, which borders on the lake shore, Arrange- is included in the estate granted to various chiefs under the "Agreement," and I ments with feared, at first, that I would have met with some opposition, on their part, to the the chiefs. compulsory removal of their surviving tenants. Fortunately these chiefs appear to be amenable to reason, and they have promised to remove to other estates, which they own in fly-free localities inland, all the people who are now inhabiting the