﻿340 
  C. 
  F. 
  M. 
  SWYNNERTON. 
  

  

  would 
  have 
  been 
  a 
  less 
  important 
  factor 
  here 
  than 
  in 
  (at 
  least) 
  the 
  first 
  village 
  type 
  

   I 
  described, 
  and 
  that 
  the 
  victims 
  probably 
  became 
  infected 
  independently 
  in 
  

   visiting 
  the 
  area 
  containing 
  infected 
  tsetses. 
  It 
  was 
  hardly 
  a 
  " 
  village 
  epidemic." 
  

  

  The 
  distance 
  from 
  the 
  bush 
  is 
  here 
  probably 
  sufficient 
  for 
  future 
  purposes 
  in 
  view 
  

   of 
  the 
  fact 
  that 
  the 
  country 
  about 
  is 
  cleared 
  and 
  settled 
  and 
  supervisable, 
  and 
  that 
  

   the 
  highly 
  infective 
  bush 
  villages 
  will 
  have 
  been 
  removed. 
  The 
  further 
  remedy 
  

   lies 
  in 
  the 
  prevention 
  of 
  visits 
  to 
  the 
  bush, 
  the 
  abandonment 
  of 
  fields 
  that 
  lie 
  in 
  the 
  

   margin 
  of 
  the 
  tsetse 
  country 
  or 
  wide 
  and 
  complete 
  clearing 
  beyond 
  them, 
  and, 
  

   possibly, 
  the 
  cutting 
  back 
  of 
  the 
  euphorbia 
  hedge 
  to 
  a 
  height 
  at 
  which 
  it 
  will 
  still 
  be 
  

   serviceable 
  for 
  cattle 
  but 
  will 
  not 
  give 
  shade. 
  

  

  Probably 
  many 
  of 
  the 
  villages 
  to 
  be 
  evacuated 
  will 
  afterwards 
  occupy 
  the 
  position 
  

   of 
  this 
  village 
  in 
  relation 
  to 
  the 
  bush, 
  owing 
  to 
  congestion 
  further 
  in, 
  and 
  the 
  prevention 
  

   of 
  the 
  natives 
  from 
  visiting 
  the 
  bush 
  is, 
  temporarily, 
  a 
  matter 
  of 
  importance. 
  

  

  XVII. 
  — 
  Duration 
  and 
  Course 
  of 
  the 
  Infection. 
  

   Possible 
  Date 
  and 
  Original 
  Locality. 
  

  

  There 
  was 
  a 
  regular 
  passage 
  of 
  natives 
  for 
  trading 
  purposes 
  between 
  the 
  now 
  

   infected 
  area 
  and 
  the 
  Mori, 
  Shirati 
  and 
  even 
  Kavirondo 
  before 
  the 
  war- 
  — 
  that 
  is, 
  

   with 
  areas 
  involved 
  in 
  the 
  original 
  great 
  gambiense 
  outbreak 
  — 
  but 
  the 
  evidence 
  to 
  

   the 
  time 
  of 
  my 
  leaving 
  Musoma 
  seemed 
  to 
  place 
  the 
  beginnings 
  of 
  the 
  Simiyu 
  outbreak 
  

   at 
  a 
  later 
  date. 
  The 
  natives 
  everywhere, 
  as 
  well 
  as 
  Messrs. 
  Zimmerman 
  and 
  Buttler, 
  

   of 
  the 
  Ngasamo 
  Mine, 
  stated 
  that 
  they 
  were 
  certain 
  that 
  the 
  disease 
  was 
  not 
  present 
  

   before 
  the 
  war. 
  Manangwa 
  Salim, 
  of 
  Basheshi, 
  who 
  was 
  with 
  Von 
  Lettow 
  till 
  the 
  

   armistice, 
  told 
  me 
  that 
  subsequently 
  to 
  his 
  return 
  there 
  was 
  increasing 
  talk 
  of 
  cases 
  

   of 
  " 
  safula," 
  or 
  ankylostomiasis, 
  for 
  which 
  the 
  natives 
  till 
  lately 
  mistook 
  it, 
  though 
  

   the 
  first 
  cases 
  of 
  the 
  present 
  disease 
  that 
  he 
  is 
  himself 
  sure 
  of 
  were 
  observed 
  three 
  

   years 
  ago 
  at 
  Igombe, 
  where 
  last 
  year 
  deaths 
  were 
  already 
  particularly 
  numerous. 
  

  

  Questioning 
  of 
  the 
  chiefs 
  elicited 
  references 
  to 
  alleged 
  early 
  cases. 
  Thus 
  a 
  Msikuma 
  

   disbanded 
  at 
  the 
  end 
  of 
  the 
  war 
  after 
  serving 
  first 
  the 
  Germans, 
  then 
  the 
  British, 
  is 
  

   said 
  to 
  have 
  then 
  come 
  straight 
  to 
  Luguru 
  already 
  showing 
  sleeping 
  sickness 
  symptoms 
  

   and 
  to 
  have 
  died. 
  He 
  may 
  have 
  contracted 
  infection 
  on 
  his 
  way 
  from 
  Mwanza. 
  

   At 
  the 
  beginning 
  of 
  1919 
  a 
  man 
  from 
  Kilehiji, 
  four 
  miles 
  north 
  of 
  Luguru, 
  on 
  the 
  edge 
  

   of 
  the 
  bush, 
  was 
  taken 
  to 
  hospital 
  in 
  Mwanza 
  by 
  Sultan 
  Mwanilanga 
  with 
  symptoms 
  

   that, 
  according 
  to 
  the 
  Sultan, 
  were 
  completely 
  identical 
  with 
  those 
  of 
  the 
  present 
  

   outbreak. 
  The 
  disease, 
  however, 
  does 
  not 
  seem 
  to 
  have 
  been 
  recognised 
  as 
  sleeping 
  

   sickness 
  in 
  Mwanza, 
  where 
  he 
  died 
  shortly 
  afterwards, 
  after 
  an 
  illness 
  that 
  had 
  

   lasted 
  in 
  all 
  eight 
  months. 
  A 
  man 
  named 
  (or 
  from 
  ?) 
  Yikiji 
  was 
  said 
  at 
  Luguru 
  to 
  

   have 
  contracted 
  the 
  disease 
  four 
  years 
  ago 
  and 
  died 
  two 
  years 
  later. 
  Sultan 
  Tobias, 
  

   of 
  Usmao, 
  about 
  fifty 
  of 
  whose 
  people 
  have 
  died 
  this 
  and 
  last 
  year, 
  spoke 
  of 
  the 
  

   death 
  last 
  year, 
  with 
  sleeping 
  sickness 
  symptoms, 
  of 
  a 
  woman 
  who 
  had 
  been 
  ill 
  for 
  

   three 
  years. 
  Several 
  natives 
  — 
  and 
  this 
  seems 
  much 
  more 
  important 
  — 
  stated 
  that 
  

   the 
  first 
  cases 
  of 
  what 
  was 
  then 
  called 
  " 
  safula 
  " 
  (hookworm), 
  but 
  is 
  now 
  recognised 
  

   as 
  " 
  malali 
  " 
  (trypanosomiasis), 
  coincided 
  with 
  the 
  end 
  of 
  the 
  great 
  famine 
  of 
  1918. 
  

  

  Naturally, 
  native 
  diagnosis 
  cannot 
  be 
  relied 
  on, 
  and 
  some 
  of 
  these 
  may 
  not 
  have 
  

   been 
  cases 
  of 
  trypanosomiasis, 
  but 
  the 
  more 
  prominent 
  symptoms 
  — 
  the 
  oedematous 
  

   feet, 
  dry 
  skin, 
  large 
  appetite, 
  distended 
  stomach 
  and 
  growing 
  emaciation 
  — 
  were 
  a 
  

   combination 
  that 
  is 
  readily 
  remarked 
  and 
  was 
  always 
  quoted, 
  so 
  that 
  if 
  no 
  evidence 
  

   to 
  the 
  contrary 
  has 
  been 
  obtained 
  since 
  I 
  left, 
  the 
  epidemic 
  would 
  appear 
  quite 
  

   likely 
  to 
  have 
  started 
  from 
  five 
  to 
  six 
  years 
  ago. 
  That 
  it 
  had 
  already 
  started 
  at 
  

   the 
  beginning 
  of 
  1918 
  is 
  shown 
  by 
  the 
  one 
  really 
  reliable 
  piece 
  of 
  evidence 
  available. 
  

   Dr. 
  A. 
  Balfour 
  tells 
  me 
  that 
  in 
  Mwanza, 
  on 
  2nd 
  April 
  1918, 
  he 
  found 
  unusual 
  numbers 
  

   of 
  trypanosomes 
  — 
  as 
  numerous 
  nearly 
  as 
  the 
  red 
  cells 
  — 
  in 
  a 
  slide 
  made 
  from 
  the 
  

   blood 
  of 
  a 
  patient 
  from 
  Usmao 
  who 
  had 
  died 
  shortly 
  before, 
  which 
  was 
  submitted 
  

   to 
  him 
  for 
  confirmation 
  by 
  Capt. 
  J. 
  Currie. 
  

  

  