Hoppe Kirk Arden. Lords of the Fly: Sleeping Sickness Control in British East Africa, 1900–1960 . Westport, Conn: Praeger, 2003. xii + 203 pp. Photographs. Maps. Bibliography. Index. $67.00. Cloth.

HEALTH & DISEASE Kirk Arden Hoppe. Lords of the Fly: Sleeping Sickness Control in British East Africa, 1900-1960. Westport, Conn: Praeger, 2003. xii + 203 pp. Photographs. Maps. Bibliography. Index. $67.00. Cloth. African trypanosomiasis, also popularly known as sleeping sickness, is caused by flagellated protozoa of the genus Trypanosoma. There are numerous species of Trypanosoma, some of which uniquely infect animals. However, only the subspecies of Trypanosoma brucei infect and cause disease in humans. These subspecies are Trypanosoma brucei gambiense, found primarily in central and West Africa, and Trypanosoma brucei rhodesiense, present in much of East Africa. The former causes a milder and less acute form of the disease than the latter. Both organisms initially infect the hemolymphatic system and then inevitably the central nervous system, where they cause a meningoencephalitis that leads to a somnolescent state, coma, and death. African trypanosomiasis is transmitted by the bite of tsetse flies that belong to the genus Glossina. There are a score of species of tsetse and numerous subspecies. The ecology of the disease is rendered complex by the existence of animal reservoirs for trypanosomes and the ability of the latter to undergo genetic change in the mid-gut of the fly, thus altering already existing virulence. Glossina have specific environmental requirements for survival and reproduction, including vegetation characteristics and temperature. Unlike most flies, Glossina possess a viviparous method of reproduction in which eggs are not laid, but rather a single larva is produced and nourished within the fly's uterus. Larvae are deposited on the ground in the shade, pupate, and eventually emerge as flies. Flies infected with trypanosomes tend to have a longer period of probing while biting, thus ensuring more efficient transmission of the parasite. African trypanosomiasis is a devastating and deadly disease in both its endemic and epidemic forms. According to the book reviewed here, it killed perhaps a quarter of a million people during the epidemic in Uganda at the turn of the twentieth centuryu. However, trypanosomiasis in Africa is often a disease that goes undetected in the absence of active surveillance and screening. The late Benitieni Fofana, minister of public health and social affairs of Mali, once summed this up for me when he said: "Epidemics of trypanosomiasis do not exist until you start looking for them" (personal communication, 1974). Kirk Arden Hoppe observes that the statistical disappearance of trypanosomiasis during the 1960s and 1970s was most likely due to a decline in surveillance, screening, and control efforts on the part of poorly resourced, newly independent African states. The increases noted in the 1980s and 1990s may not necessarily have represented a true rise in incidence, but simply the fact that public health authorities began looking for the disease. The case management of patients infected with trypanosomiasis has always been very challenging because of the toxic nature of the drugs used, their administration either intravenously or intramuscularly over prolonged periods of time, and the need for an infrastructure of well-trained medical personnel and laboratory facilities to examine blood and cerebrospinal fluid. Patient compliance with courses of treatment is often difficult to maintain, not only because of drug side effects, some of which are severe and life threatening, but also because of their duration. Kirk Arden Hoppe is an assistant professor in the history department at the University of Illinois at Chicago. His study of colonial sleeping sickness control in East Africa came about as a result of his research into the history of fishing on Lake Victoria, an important epicenter for the disease, especially at the beginning of the twentieth century. He has attempted to write an "environmental history of British colonial sleeping sickness control that examines the social and cultural meanings of depopulations, resettlement, and brush clearing in East Africa" (3), framing his discourse within the rhetoric of postcolonialism and establishing his central arguments in a hermeneutics of suspicion. …