Sleeping sickness: being an account of the investigations of the Commission of the Royal Society in Uganda, the Nile Valley and Sudan, from May 1903 to February 1905

Abstract

I was directed by the Government of India in April 1903 to proceed to Uganda to investigate Sleeping Sickness on their behalf, in order to obtain exact information regarding it, so that measures might be taken to prevent it's gaining an entrance into India. A Commission had just been appointed by the Royal Society for this purpose. The Government of India, through the Secretary of State, asked permission from the Royal Society for me to join the Commission as their Representative. This sanction was given, and I met the Commission in Uganda on 25th May 1903. The Commission was composed of Col David Bruce F.R.S. Dr Nabarro and Myself. We worked together until Aug 1903, when Col Bruce left for England. Dr Nabarro left shorly after. I continued the work alone elaborating and extending the investigations in Uganda until Nov 1904 I then conducted an expedition to Lake Albert and from there down the Nile through the Sudan and Egypt. The object of this expedition was to determine for the Uganda Administration, whether Sleeping Sickness was present on the shores of Lake Albert and if so, to determine exactly the distribution of the disease and the fly on the Lake and down the Nile: and further, for the information of the Government of Egypt, how far, if at all, the fly extended into the territory of the Sudan; a matter of great practical importance in view of the possible northward spread of the disease into Egypt.I propose, in this Thesis, to bring forward the results of the work of the Commission. The work done by us up to the time of Col Bruce's departure for England has been published in the Reports of the Sleep-Sickness Commission of the Royal Society No 4, Nov 1903. The investigation carried on by me until my arrival in England, on leave, in Feby 1905, has formed the subject of a Report, which has been submitted to the Royal Society. The Royal Society having decided to publish this Report, it is now being printed by the Stationery Department at the request cf the Royal Society. I had the assistance of Lieut Gray R.A.M.C. in the work from March to Nov 1904, but the investigations were under my direction, and I was entirely responsible for them from the time of Col Bruce's and Dr Nabarro' departure. The Report presented by me to the Royal Society was drawn up by myself. Having thus detailed the work done in conjunction with my Colleagues on the Commission and that done by myself, I shall now, set forth the results of our researches in their entirety and proper sequence.Since in this Report a good deal of detail will be given, the propositions, that this Thesis brings forward evidence to prove, may be briefly stated:-1. That sleeping sickness is caused by the entrance into the tissues cf a species of trypanosoma.2. That this species is, probably, that discovered by Forde and described by Dutton from the West Coast of Africa and called by him the Trypanosoma gambiense.3. That so-called cases of Trypanosoma Fever from the West Coast are cases of sleeping sickness in the earliest stages.4. That enlargement of lymphatic glands containing trypanosornes in large numbers is the essential feature of Trypanosoma Fever: sleeping sickness is Trypanosoma Fever with in addition, signs and symptoms due to changes in the nervous system, and the appearance cf these symptoms synchronises with the appearance in number of the trypanosomes in the cerebro-spinal fluid.5. That 70 to 80% of the general population of the sleeping sickness areas of Uganda are in the early stage of the disease.6. That monkeys are susceptible to sleeping sickness, and show the same symptoms and run the same course, whether the trypanosomes are derived from cases of trypanosoma fever, or from the cerebro-spinal fluid of cases of sleeping sickness. The pathological changes found in man in cases of sleeping sickness can also be reproduced in monkeys.7. That dogs, rats and guinea-pigs are partially susceptible, but donkeys, oxen, goats, and sheep have proved absolutely refractory.8. That the trypanosones are conveyed from the sick to the healthy by a species of tsetse fly, Gloss-fina palpalis, and possibly certain other varieties of tsetse flies (Glossina pallidipes, norsitans, fusca and lengipennis).9. That the distribution of sleeping sickness and Glossina palpalis correspond.10. That sleeping sickness has recently infected the fly belt of the Albert Lake and it has spread down the banks of the Nile to Wadelai (about 100 miles); it will continue, under existing circumstances, to spread until it reaches the limit of the fly belt on the Nile.11. That sleeping sickness is,in short,a human tsetse fly disease, and the lymphatic system is mainly involved.The stage at which our knowledge of the etiology of this disease in Uganda had reached on the arrival of the Commission was, that the cause of the disease was a streptococcus (CASTELLANI). Whilst searching for this organism in the cerebro-spinal fluid of sleeping sickness cases, Castellani saw, in 5 cases atrypanosoma, but, at that time, he was of opinion, that this was an accidental concomitant, like Filaria perstans. Accordingly the Cmmission had to determine, 1) The exact cause of the maladv; 2) How it was spread from the sick to the healthy. In a Conference held on the 22nd March 1905, between the Royal Society, Colonial and Foreign Offices, the Royal Society, in a Memorandum, held that these facts had been satisfactorily proved by the researches of the Commission in Uganda. This Memorandum was based on the Reports submitted by their Commission on sleeping sickness in Uganda.