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Muscles and their Nerves

Trypanosomes and their tsetse fly vectors have often been described as the real rulers of tropical Africa, responsible for devastating epidemics of human sleeping sickness and of "nagana," the dreaded disease of horses and cattle. It has been assumed that the successful control of these two infections was one of the beneficial consequences of the colonization of Africa. This well documented and wholly absorbing book by the former director of the East African Trypanosomiasis Research Organization throws a new light on the past history of trypanosomiasis. It may destroy some cherished illusions, while it shows that the old concepts of circumstantial epidemiology of trypanosomiases formulated during the first half of this century should be revised. It indicates the complexity of the whole problem and the need for better ecological knowledge before we define the aims, ways, and means of control let alone elimination of this disease. In this respect the book may generate some controversy. An introductory chapter describes the relationships of the main factors involved in the transmission of the infection, and four further chapters deal with the distribution and behaviour pattern of the vectors and with the biological characteristics of the parasites. Histories of five outbreaks of trypanosomiasis occupy the main part of the book, and a detailed account is given of the situation in three large areas round Lake Victoria, in Rhodesia, and Nigeria. The concluding chapters outline the continental aspects of tsetse-borne trypanosomiasis and the new approach to it. The author believes that the epidemics of trypanosomiasis seen at the beginning of this century were indirect consequences of the major political, administrative, ecological, and other changes that accompanied the colonial occupation of Africa. Though the subsequent scientific and medical achievements of the governments have improved the general health, the new historical phase of the end of the colonial period may be followed by epidemics as devastating as those that accompanied its inception. Some degree of intervention may be needed to prevent the infection getting out of hand, but any policy of extensive elimination of Glossina or of trypanosomes without regard to the general ecology of the country and on a scale unrelated to the potential for its social adjustment and economic growth may be disastrous. Policy should be based on the assessment of the prospective development in each area and on a better understanding of the epidemiology and epizootiology of tsetseborne diseases. Blunderbuss interference by mass treatment, by blanket spraying with insecticides, by destruction of game, or by deforestation may temporarily control the spread of the infection but at an unknown cost in health and welfare of the future generations. This does not mean that the known foci of trypanosomiasis must remain inviolate, but that a judicious degree of integrated control should not unduly upset the precarious balance between the parasite, its insect vector, the human or animal host, and the multifaceted environment. This book provides a large number of factual data neatly interwoven to show the fascinating web of the natural history of one of the major diseases of the tropical world. It leaves the attentive reader in a contemplative mood, as he realizes how much more knowledge is still needed and how little of it has been used wisely and well. The author does not offer any ready answers to those who would like to learn when to control an outbreak of trypanosomiasis and when to refrain from interfering with the delicately adjusted equilibrium of the stable relationship found in natural conditions. In a recent essay on the historical perspective of African trypanosomiasis Duggan said that "as the scientific weapons at man's disposal increase in range and power, so the temptation towards total environmental interference at all costs will inevitably grow," and in this respect Ford's views are shared by several experienced workers. Too much reliance on some future ecological disclosures or on the prospective fruits of "formal epidemiology" based on quantative approach may at times become an excuse for inaction, though this is certainly not the message of this important book that will be read with profit by all those who are involved in the improvement of health and socioeconomic conditions of tropical Africa.