466 SCIENCE IN AFRICA 



societies. Though medical work is only a small part of missionary 

 activity, the number and standard of hospitals and health centres 

 supported by missions make some mention of this body essential 

 in any survey of international organizations interested in health 

 questions in Africa. 



The control of epidemics calls for a considerable degree of 

 international co-operation. The danger from air transport, which 

 is now fully recognized, is discussed in a later section on yellow 

 fever. Other forms of transport, such as rail and motor, are easy 

 to control, but the spread of epidemics by travellers on foot presents 

 more difficult problems. It has been emphasized by some experts 

 that international organization falls short in this respect and that 

 the question is of special importance in those parts of Africa 

 where natives continually cross the numerous frontiers to trade or 

 seek work. Successful control depends on the immediate notifica- 

 tion of disease outbreaks from territory to territory, supplemented 

 by a system of medical passports recognized on both sides of the 

 boundary. International notification has been in force in West 

 Africa for about the last twelve years, but has not always worked 

 satisfactorily. Wireless communication offers opportunities for 

 advance in this respect, and is already in use, especially at the 

 chief ports in connection with shipping and port health work. 

 There seems to be scope for an enlargement of these services on an 

 international footing, to provide a system of wireless communiques 

 which would be picked up by health services and ships along the 

 coast. A precedent for this already exists in the Singapore epi- 

 demiological broadcasts mentioned above. 



Existing regulations regarding medical passports in Africa do 

 not as yet achieve their aim in all cases. Along certain frontiers 

 conveniently situated for administrative control, every native has 

 to carry a paper concerning the state of his health, but it appears 

 that these passports are not always recognized in the neighbouring 

 country, and there are wide stretches of frontier where no such 

 control yet exists. As an example, a medical passport system has 

 been established on the border between Uganda and Tanganyika 

 west of Lake Victoria, in order to prevent the northward spread of 

 the rhodesiense type of sleeping sickness. Here the Kagera River, 

 which forms the frontier, can only be crossed at four points where 



