EEVIEW — TEOPICAL MEDICINE, ETC. 177 



(g) It is most important to consider, with regard to prevention, the width of the fly-ranges (infective areas) Sleeping 

 and the constant traffic with these from inland. Sickness 



(h) The most important and most practical preventive measures at the present time appear to be a continv.ed 



combination of the clearing and of segregation from the infective areas, with or without deportation. Also the 

 segregation in fly-free country will favour the administration of any special treatment. 



(i) Our action in the Nile Province, the Nile itself not being a true intertribal boundary, and there being 

 constant migration from bank to bank, must depend on the result of our enquiries into the capacity of Glossina 

 7norsita)is and 0. pallidipes of carrying the infection, and also the action (if any) which may be taken by the 

 Sudan, and, especially, the Congo Free State Governments in the m.atter. 



(j) The natives of the Uganda Protectorate, by keeping their sick from the water side, their dwellings 

 outside the fiy-range, and their water supplies, fords, ferries, landing, markets, etc., cleared of undergrowth ; 

 placing them, wherever possible, in fly-free situations could, in all probability, themselves control the disease ; 

 and though it is not likely that the bulk of them will yet attempt it, it is possible that they may in the course of 

 years gradually acquire a habit of using the defensive measures now proposed. 



(k) It is probable that sleeping sickness may remain endemic in certain parts of the Protectorate which wUl 

 become localised as time goes on. Whether the lake-shore or Nile-bauk regions will remain permanently 

 dangerous to a population living in them will depend chiefly on the natives themselves. 



(I) It is most import-ant that the duration of infection in the fly should be determined. 



(m) In the Uganda Protectorate, although it may be impossible to eradicate sleeping sickness in a few 

 endemic centres, I believe there is good ground for hope that the present epidemic may be so far controlled, over 

 the greater part of its extent, that the disease, even though we fail to find effectual and practicable cure, may 

 cease to be a menace to the population and a serious obstacle to the development of the country, and, further, that 

 fresh outbreaks of anjrthing like the dimensions of the present one should become almost impossible of recurrence 

 in the future. 



As regards the action of the Sudan, to which reference has been made, this, so far as the 

 Nile is concerned, will be found detailed in the Second Report of these laboratories. It will 

 be remembered also that all recruiting from Uganda was stopped. 



Koch has made the following recommendations : — ■ 



1. Sick natives should be prevented from crossing the frontier. 



2. A native found to be infected, no matter in what country or from what country, should be detained where 

 he was infected. 



3. Each country should interdict its natives from entering infected districts. 



4. Segregation camps should be established. 



5. Attempts should be made to destroy crocodiles, which Koch believes are the principal food-source of 

 the fly. The eggs of the saurians should be destroyed and the adults poisoned. 



6. Scrub and undergrowth should be cleared whether they constitute fly-belts or may afford dangerous 

 shelter for flies, i.e. round posts and villages with water in their vicinities. 



Some of these recommendations have been severely criticised, ' and, although excellent in 

 theory, would seem to be difficult if not impossible of achievement, considering the 

 conditions which obtain in the countries infected. 



Koch thinks the crocodile essential to the fly and the determining cause of its presence, 

 because both abound in the regions of Lakes Tanganyika and Nyanza, while in Lake Kivu 

 there are no crocodiles and Q. palpalis is absent. Hodges, however, has shown that, in Lake 

 Albert Edward, crocodiles are absent and G. palpalis ahownds, while south of Gondokoro the 

 reverse is the case. He thinks the fly may feed on tlie hippopotamus at times. Most of 

 those to whom one has spoken on the subject seem to think that the tsetse will take blood 

 from any available source, naturally preferring that which is most convenient and yields 

 an abundant supply. 



Cook^ has stated that — 



From the point of view of prophylaxis four important methods were being adopted in Uganda. First, 

 those actually suffering from sleeping sickness were being collected so far as possible and segregated in isolation 

 camps, where each man, the presence of trypanosomes having been verified in his body, underwent thorough 

 treatment with atoxyl. Every care was taken to remove prejudices from the native mind, and an excellent 

 work was being done. The second method was the compulsory eviction or removal of all natives from infected 

 t.setse-fly areas. That bristled with difficulties. The Uganda police were too few in number to patrol a large 

 area efficiently. The mitives clung to their old homes and plantations and not one in a thousand believed 

 that the tsetse fly, which they call " Kivu," really conveyed the disease. Sloreover, the islands, the worst 

 foci of the disease, were almost necessarily left alone. The third method was the clearing of extensive areas 

 round landing stages, markets on the lake shore, watering places, and the necessary Government, or trading, 

 stations on the lake. The fourth method w.as the printing in the native tongue of clear instructions as to 



' Leader in the Jmimal of Tropical Medicine and Hygiene, February 15th, 1908, p. 55. 

 " Cook, A. R. (October 26th, 1907), " Report of Meeting of Society of Tropical Medicine and Hygiene." 

 Lancet, Vol. II. 



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