_ -—___7 . _.‘ ~ ‘ . .cc \.. .‘ .C. ~~.c- - ....--.-.-.. w.--o‘..v~a~--.--~.o .. .~ - —— .- - .. * .— -—. . {w ‘ I'I ' O _. ' I o . I ---- A GEOGRAPHY 0F macaw AND ‘ - - 7_ f TUBERCULOSIS IN AFRICA . ~; _;z AND _' V ", . ‘5§i172§’f}f7dké ,. LAND USE ASSOCIATED WITH SAND AND GRAVE <3? summon DNA PORUON or THEMASON ESKER Two Research Papers for the Demzof 1A.}; ’ MICHIGAN STATE umvmsmr ' NKHHUS(1HHHOMMSE 1971 i 29503511 réx“;.IBR.4RYJaT€ n M NW N! WW! ”I [H { JIM/Ill?! W!!! Michigan 5m 3 1293 10275 9663 University A GEOGRAPHY OF LEPROSY AND TUBERCULOSIS IN AFRICA BY Morris 0. Thomas A RESEARCH PAPER Submitted to Michigan State University in partial fulfillment of the requirements for the degree of MASTER OF ARTS Department of Geography 1971 45) (%4k M ‘ /%/LVZ/V%V Approved V ACKNOWLEDGEMENTS The writing of this paper was made possible through the assis— tance of a number of people. Appreciation is gratefully extended to the staff members of the Michigan State University Science Library and Kresge Memorial Library at the University of Michigan. Special thanks is due to Dr. John M. Hunter who helped make possible the writing of this paper by the many suggestions and hours of time spent in consultation with the author. A special thanks is also extended to the author's wife, Carol, who helped in the preparation of this paper. ii TABLE OF CONTENTS ACKNOWLEDGMENTS . LIST OF TABLES LIST OF FIGURES . INTRODUCTION CHAPTER I. LEPROSY . Pattern of Leprosy Prevalence . Dynamics of Spreading . Contact . . . . . . . . Total Annual Precipitation II. TUBERCULOSIS Pattern of Tuberculosis Prevalence Dynamics of Spreading . Urbanization Migration . III. INTERRELATIONSHIPS OF LEPROSY AND TUBERCULOSIS Cross-immunology Social Implications Poverty . . . . Infection Levels IV. PREVENTION, CONTROL, AND ERADICATION CONCLUSIONS . SELECTED BIBLIOGRAPHY . iii Page ii iv 12 16 18 21 22 31 31 32 39 39 45 46 47 48 51 52 Table LIST OF TABLES Latest Estimates of Leprosy Prevalence in African Countries . Ranked Case Studies of Leprosy in Africa Age and Leprosy Infection in Northern Nigeria and Cameroon Estimated Tuberculosis Infection in African Countries . Newly Reported Cases of Tuberculosis in Africa 1966 and 1967 . . . Ranked Tuberculosis Case Studies in Africa The Prevalence of Known Cases of Leprosy and Tuberculosis in Proportion to the Population Served in Various Clinics in South Nyanza-November, 1959 iv Page 13 17 24 26 27 42 Figure 1. 2. 10. 11. 12. 13. 14. LIST OF FIGURES Leprosy Incidence a Distribution . Leprosy Belt . Leprosy Estimated Leprosy Prevalence . Leprosy Case Studies, 1970-1953 Relationship Between Leprosy and Total Annual Precipitation Tuberculosis Infection . Incidence of Newly Reported Tuberculosis Cases, 1967 . Tuberculosis Case Studies, 1971-1957 . Urban Centers with P0pu1ation Greater than 100,000 . Estimated Prevalence of Tuberculosis Infection in Urban and Rural Areas of six Countries Major Movements of Migrant Labor . Transfer of Tuberculosis-Urban to Rural Relationship of Leprosy and Tuberculosis in South Nyanza, Kenya Page 11 15 19 28 29 30 33 34 35 38 43 INTRODUCTION Disease has had a major impact upon the African continent, pre- sently and in the distant past (Hughes and Hunter, 1970, pp. 445). In Africa as in other parts of the world, diseases are part of an intricate System of interacting forces. A particular health problem is contingent upon a host of social, economic, and climatic factors. The principal in- gredients of health problems are always the same throughout the world- men and diseases interacting (Bryant, 1969, p. 19). The purpose of this research is to peruse the literature that pertains to leprosy and tuberculosis in Africa and to discern patterns, trends, and impacts of leprosy and tuberculosis. It has been estimated by the World Health Organization (WHO) that 35.8% of the world's leprosy cases are in Africa, a continent which contains 10% of the world's population (Bulletin World Health Organization, 1966, p. 811). In Zambia tuberculosis ranks second to pneumonia as the most serious health problem (Cove, 1967, pp. 52-54). During 1961, WHO conducted a tuberculosis survey in Kenya. The results indicated 110,000 cases in a population of 6,000,000 (Roelsgaard and Nyboe, 1961, p. 868). Leprosy and tuberculosis offer an opportunity to study two diseases in which there appears to be cross-immunization.l The exact mechanism of 1Leprosy and tuberculosis both are caused by acid-fast bacteria (Mycobacterium) which have some morphologic resemblance. the immunological relationship is not known, but it is thought that pop— ulations with a high prevalence of tuberculosis may have increased resis- tance to and hence lower prevalence of leprosy (Grounds, 1964, p. 13). This may be due to the fact that both diseases are chronic and infectious. Tuberculosis is more infectious and spreads more rapidly in non-immune populations than does leprosy (Chaussinaud, 1953, p. 90). Populations heavily infected with tuberculosis are said to be afforded some protection from leprosy which has a longer incubation period and slower spread. Tu- berculosis tends to spread faster in the densely populated areas and has ousted leprosy except in the less populated regions where it eventually died out (Grounds, 1964, p. 13). This phenomenon of cross-immunization also takes place with respect to yaws and syphillis (Taneja, 1967, p. 215). Both leprosy and tuberculosis are on the verge of becoming "tropical diseases" in that infection rates are significantly lower in extratropical regions.2 The transmission of an infectious disease requires three factors: (1) a susceptible human population, (2) a bacterium or other disease agent, and (3) close contact between infected and non-infected humans, with per- haps a vector. In order for a disease to occur in endemic proportions, all three factors must be present in close proximity of each other. Each portion of the transmission cycle can be expressed geographically. Each factor in the cycle has a particular ecology to which it is best suited. By attempting such an investigation perhaps the nagging problem of why and how some people become infected, while others do not, can be understood. 2The author is not making the assumption that "tropical” carries only a climatic designation. Chapter 1 LEPROSY Leprosy is a chronic, infectious, and communicable disease caused by infection with Mycobacterium leprai. The tissues principally affected are those of the skin and peripheral nerves. The leprosy bacillus is the acid-fast type which closely resembles the organism which causes tubercu- losis, mycobacterium tuberculosis (Arnold, 1967, p. 296). There are two principal types of leprosy as recognized by the Sixth International Congress of Leprosy at Madrid, 1953, and reaffirmed in Tokyo in 1963. These are as follows: A. The Lepromatous type- The patient manifests no resistance to the disease. This type is progressive and found primarily in skin lesions producing swelling. It usually occurs sym- metrically in the patient. If untreated it is usually fatal in 10 to 20 years (Arnold, 1967, pp. 297-299). B. The Tuberculoid type- The patient manifests a vigorous resis- tance to the disease which usually attacks the nerves and interferes with their function. Sensation and muscular power are diminished. One early sympton is the loss of ability to feel pain or temperature changes in limited patches of the skin. Usually such conditions are not debilitating at first and go unattended (Wilcocks, 1950, p. 90). Unlike the leproma— tous type, the occurence is a symetrical and sudden. Spon- taneous recovery usually occurs in l to 3 years if untreated (Arnold, 1967, p. 299). Leprosy is transmitted from infected cases to uninfected cases through close, prolonged, and intimate contact with the source of infec- tion (Badger, 1964, p. 70). The exact mode of transmission from man to man is still unknown. The bacilli are commonly believed to enter either via the nasal mucous membrane or through the skin (Cahill, 1964, p. 141). Other researchers believe the portals of entry are through the respira- tory tract and open wounds on the body (Badger, 1964, p. 70). Treatment of leprosy is based primarily upon chemotherapy utilizing the sulfones. Presentlydiaminodiphenylsulfone (DDS) is the most widely regarded drug used by leprologists. Dosage of specified amounts continue until skin lesions and nasal mucosa are healed and devoid of the bacilli. The time period involved is at least two or three years and rarely more than eight years. Maintenance therapy to prevent relapse is necessary for most patients. For those who cannot tolerate the sulfones, amizthio- zone is a suitable replacement (Arnold, 1967, p. 301). The general impression is that leprosy is not distributed at random throughout the world, and that it is inefficient in its method of survival. Transmission may be difficult and associated with a massive infecting dose or an intimate method of transfer and/or environmental factors about which there is insufficient information at the present time (Newell, 1966, p. 834). It is in this light that an analysis of the prevalence of leprosy is under- taken. The main thrust of the investigation will be the study of the dis- tribution of the disease among the population in Africa and the search for determining factors of such a distribution. Pattern of Leprosy Prevalence The spatial dimensions of leprosy prevalence in African countries offer investigators in the opportunity to define a "leprosy belt.” Using sources up to 1952, Nelson depicted the distribution of leprosy in African countries. Rates of 10 per 1000 and above occur in a definite area from Malagasy Republic to Western Nigeria. Another area of high rates occurs in Senegal, Gambia, Portuguese Guinea, and Guinea (Figure 1). liIillIJIl.l1lll‘1llilllll1 ||I "20 I— L2H > Figure 1 .m .o .w .m .m Q 2 2 O m n T I . S o a at a“ a m r i o h m. i 0 4m m; R n m r N w 0 10 m a II. . .04 T m I 5 U e n w m a n N. Y R m A o S T E R S 0 S c a n I N 0 fl R D E N 0 N R E P 8 E m m u o E F C E .v o rm L E .m— m L d mi C N O E D C N .w . .o . .m h The National Academy of Science- National Research Council pub— lished a map (Figure 2) of the estimated prevalence of leprosy in 1958. The "leprosy belt" appears to extend nearly uninterrupted from the Mozambi- que littoral through Senegal on the Atlantic coast. Modifications from Nelson's map include elimination of Madagascar (Malagasy Republic), the northeastern portion of Zambia and the southern portion of Nigeria (lands south of the Niger and Benue Rivers) from the ranking of the most highly endemic areas. Western Nigeria, the Guinea coast, and the Savanna states are included in the hyperendemic zone. Also included are the areas of equatorial Africa (Gabon, Congo (B), Eq. Guinea, and Cameroon). The pos— sible expansion of the "leprosy belt" appears to demonstrate better "hunt— ing techniques" and reporting procedures. Schaller published a map of estimated leprosy prevalence in African countries (Figure 3)3. Schaller's modification of the "leprosy belt" is removing Mozambique and Malawi from the hyperendemic group. A visual con- striction of the "leprosy belt” appears from the comparison of Figures 2 and 3. A limitation in comparing the two maps arises because of a lack of quantitative values attached to the legend. To assess the present pattern of leprosy the most recent prevalence estimates were ranked from highest to lowest (Table l). The occurence of leprosy shows a disintegration of the "leprosy belt" into two regions with rates greater than 28,700 per million (Figure 4). The Central African Re- public and Zaire (Congo, K.) form a region separate from those countries near the headwaters of the Niger River (Mali, Guinea, Portuguese Guinea, Ivory Coast, and Upper Volta). 3N0 quantitative values were given in the source for the patterns shown in Figure 3. >- do. n5 1'. If 1'. '. LEPROSY BELT PREVALENCE PEN M IL LION POPULATION amen (our I500) amount: (Isoo-Ioom [ZnLow “000-500) EVERY LOW (below 500 from TROPICAL HEALTHJSSB o 300 .00 000 "LES 20’ 0' 20' 40° 5°. 40‘ 20°J 20" 4 0.4 Figure 2 I o 0 50. 4t) I o I—_ ‘— ’ ' -— ——~ ~ _ -. _ 60 ,0. L E P R o s Y 4094 I-rll'” A I m ‘ A " -._ ‘— ' ‘~ I \ \ ’ x ' ' ~ ‘- ’20. 3' i \ ‘ I \ ~ I IV . ‘., : ~Vf"IIIII I I ’I ' I “ OJ :0:0;.';ooc‘v‘v O o...'.'¢' .'. 20 $914,240.£030.;zgo'geggg. ;. 'o‘o’o ‘ 9 ‘ 00% 0 ie 0 0' ’ 900‘00'.ooooo.eoo 0. 0'00090099v00 . o0 090000000 0 0.000 0.000000 .0 00 0.0.00.0 0 Jr «9 O 0 O o (a n O o O O O 0 O o 9 O o o o o O O o 0.). , o "46090.0," .. 9 e. \ O. .% 0 ° 0 ~ 0 0” gap 00 0 ”fig gap». «% 3‘3 IVVDJVVW§9VV5O N oooooooooeooooo 000000 0 000000 e o o 00%“ o o "20’ m VERY HIGH O o O§§°§°§o 9 09¢ : .o" O. o . ....O O (0%.:9. ... 34°91 N 17% a: 0.. 9°. o .0 o o e . Q \ ~ . o ()4 K2 mew . ) . a m MEDIUM , ~. 20 ‘} I B Low -. ulna VERY LOW ”13 no DATA AVAILABE {I} 40... after SCHALLER, [969 30° ‘00 too . “£55 2J3. L 20. 40° 60. Figure 3 Table l.--Latest Estimates of Leprosy Prevalence in African Countries3 Prevalence per Year million of Countryb populationc Source Estimate Central African Republic 93,400 Bechelli et a1 1963 Upper Volta 51,000 Bechelli et a1 1963 Ivory Coast 49,900 Bechelli et a1 1964 Guinea 48,000 Bechelli et a1 1964 Eq. Guinea 45,000 Bechelli et a1 1959 Sierra Leone 40,000 Bechelli et a1 1958 Mali 34,800 Bechelli et a1 1963 Zaire (Congo, K) 34,800 Bechelli et a1 1959 Togo 34,500 Bechelli et a1 1962 Lesotho 33,000 Bechelli et a1 1959 Portugese Guinea 30,600 Bechelli et a1 1959 Dahomey 28,700 Bechelli et a1 1963 Cameroon 25,800 Martinez Dominguez 1966 Gambia 24,000 Bechelli et a1 1955 Gabon 22,200 Lechat 1968 French Afars and Issas 22,000 Bechelli et a1 1964 Liberia 21,500 Bechelli et a1 1963 Zambia 20,000 Bechelli et a1 1962 Congo (Brazzaville) 18,000 Lechat 1968 Nigeria 18,000 Bechelli et a1 1963 Uganda 17,000 Bechelli et a1 1962 Mozambique 16,500 Bechelli et a1 1962 Swaziland 16,500 Bechelli et a1 1964 Sengal 16,000 Bassett 1964 Chad 15,000 Lechat 1968 Kenya 15,000 Ziedses des Plantes 1968 Malawi 15,000 Molesworth 1967 EthioPia 15,000 Schaller 1959 Burundi 13,750 Bechelli et a1 1960 Niger 13,100 Bechelli et a1 1963 Malagasy Republic 12,000 Bechelli et a1 1965 Rwanda 11,740 Bechelli et a1 1968 Angola 11,500 Bechelli et a1 1959 Tanzania 10,000 Wheate 1969 Sudan 10,000 Bechelli et a1 1959 Ghana 8,570 Bechelli et al 1964 Mauritania 6,040 Bechelli et a1 1963 South Africa 5,260 Schulz G Pentz 1968 Botswana 4,960 Bechelli et al 1963 Zimbabwe (Rhodesia) 4,960 Bechelli et a1 1963 10 Table 1.--(Cont.)a Prevalence per Year million of Countryb populationC Source Estimate Somalia 2,220 Bechelli et a1 1959 United Arab Republic 2,220 Bechelli et al 1962 Libya 2,200 Bechelli et a1 1964 Spanish Sahara 2,020 Bechelli et a1 1964 Algeria 2,000 Bechelli et a1 1964 Morocco 2,000 Bechelli et a1 1953 Tunisia 2,000 Bechelli et a1 1964 Namibia (South West Africa) 1,170 Bechelli et al 1963 aPrevalence is defined as the proportion of the p0pu1ation who at some time have had or are affected by the disease. bNames of countries are those used by Organization of African Unity. CCalculations of rates per million were made by author (MOT) to standardize the data. 11 «0'4 201 0-4 2 o'J 40.1 V ‘1) Y- S 0 RE PC EN LE on E TV AE MR ID. T S E QUARTILE RANKING PER MILLION POPULATION 400-2 8.700) (93 (2 a VERY HIGH a men 5.800- 16.000 I “5,000- 8.579) Low (6.040 - I,|70 I E3 VERY Low a? 000 . 1.4.. L 200 «)0 MLES I SEE TABLE h ”20' >40 40 20' __L Figure 4 12 In order to gain a clear impression of the leprosy problem in Africa, one must go beyond national estimates and analyze the distribution and magnitudes of selected case studies. Case studies offer an opportunity to examine specific aspects of the epidemiology. Table 2 shows the ranking of the case study rates from highest to lowest. The time span covered is from 1953 to 1969. Studies conducted before 1953 were not tabulated on the assumption the data of that age would not contribute to the present analysis. On the basis of the aforementioned data, upper quartile rankings occur primarily in two distinct regions including Central African Republic, Zaire (Congo, K.), and Zambia in one region. The other region would be one embracing the area from Gambia through Upper Volta (Figure 5). A third area that contains slightly lower prevalence rates can discerned in the highlands of East Africa from Lake Victoria through the Amhor plateau of Ethiopia. The World Health Organization Technical Report Series No. 459 (1970) states that in areas where the prevalence of leprosy exceeds 500/ million population, the prevalence can be expected to rise even higher. Upon this basis it can be postulated that areas indicated by case studies have a severe medical problem. The approximately 3,868,000 cases found in Africa in 1965 are the reservoir upon which this increase is expected to be manifested (Bechelli, et. a1., 1966, p. 821). Dynamics of Spreading Leprosy can be contracted at any age, but infants and children appear more susceptible than adults (Manson-Bahr, 1964, p. 478). 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O 0 >4” 404 , In 6 - SEE uaIE 2 ° (Cameos L 210’ 0 20’ 40‘ 50° 16 in early childhood, and it is rare for an adult to become infected (Badger, 1964, p. 76; Table 3). The distribution up to 90% of the cases in the 5 to 44 year age bracket is thought to be partly a fUnction of exposure as young children are frequently carried along on their mother's back. Due to the long in- cubation period (3-5 years), the children exposed early in life do not show signs of leprosy until they become part of the 5-14 age group. Young adults (15-44 years) are generally the most mobile portion of the pOpulation; as a result they have a very good chance of being exposed. Contact The traditional and perhaps easiest way in which leprosy is spread has been explained by the following statement, "close prolonged contact of a susceptible person with infectious case." If A is the infectious case, capable of infecting the susceptible person B, then just what is the me- chanism that causes or allows Mycobacterium lepras to be transmitted be- tween persons? The pursuit of that mechanism has led Henry L. Arnold Jr. to write the following: The transmission of leprosy is mysterious. It is so dif— ficult to acquire that it was believed for many decades to be hereditary rather than contagious. Yet it is so easy to acquire that nearly half the patients with recently acquired disease are unaware of having any contact with another diseased person (Arnold, 1967, p. 297 in Cecil and Loeb). Not all investigators of leprosy epidemiology are on the side of the "close contact" theory. In particular, work is being urged on the possibility of fleas and lice as possible vectors. As leprosy has always been known to spread where squalor and vermin abound but to stop spreading when cleanliness 17 Table 3.--Age and Leprosy Infection in Northern Nigeria and Cameroon Per centa Rates pera Age Population of Million Group Examined Cases Cases Population Northern Nigeria-- 0-1 1,110 O - - 1-4 3,801 8 1.2 2,100 5—14 5,370 175 24.8 32,590 15-44 12,012 408 57.8 33,660 45+ 2,245 114 16.2 55.780 24,538 7057 100.0 28,700 Cameroons-- 0-1 425 0 - - 1-4 1,809 2 0.5 1,500 5-14 3,201 24 6.5 7,500 15-44 6,335 191 51.1 30,100 45+ 2,703 l§Z_ 41.9 58,780 14,473 374 100 0 25,840 Source: Martin Dominguez, V., et. al. "W.H.0. Surveys of Disabilities in Leprosy in Northern Nigeria, Cameroon, and Thailand," International Journal of Leprosy. V01. 34, No. 3, 1966, pp. 244-254. aRates per million population and percentages of cases were calculated by author (MOT). 18 of body and housing are adopted, even where contact is frequent, direct contact seems neglible (Dungal, 1960, p. 31). The idea that filth and squalor was associated with high preva- lence of leprosy is not new. T.F.G. Mayer in 1930 proposed that a poor diet (malnutrition and protein deficiency) along with overcrowding of the population caused perpetuation of leprosy. A further complicating factor in the distribution of leprosy is that in some regions, whole villages have a high rate of incidence and a uniform distribution throughout the village. However, the existence of leprosy in an endemic area may be sporadic with nearby villages having very different rates of leprosy prevalence (Cochrane et. a1., 1957, p. 11). Total Annual Precipitation Endemic leprosy areas are found primarily in regions of high rain- fall and warm temperature. While this relationship has been documented, few researchers believe that climate alone is the causative factor. His- torically high leprosy rates have not been confined to the humid tropics and subtropics, since leprosy was considered a major health problem in Medieval Europe (Newell, 1966, p. 838). Researchers in India have noted a significant increase in the number of people who seek first-time medical aid just after the onset of the monsoon rains (Charravarthy, 1966, pp. 99- 102). The author has found from an analysis of case studies in Africa that there is a definite tendency for leprosy prevalence rates to increase as total annual precipitation rates increase (Figure 6). In an attempt to fUrther refine the data, a test of correlation was conducted. The yield of a significantly high correlation value (r = +0.44l) does offer 19 '23 «8 O :2 O '0' o _ r~ C a 0 g a _ O o ,0 N - m _J O —O- 4 ' a *- O = O o '2 = ° 3 I— '-' ' o 'o' '2. Z 7 :5 4 g :5 .. ‘ 8 z; 0 = 0. e e e 8 C>2 '? E a :0 ° :3: = 8 ,n 0 II." 7 3~ 09: ' " EU .0 0 DJ 50: _ “' Zn. '5 9.1 2;): age .J LIJZ 0:4 4* A A A A A A —A A A r o o o o o o g : 9 co 0 2 In 3 3 3 8 2 ° NOILV'IOdOd NOI‘I‘IIN 83d 30N3‘IVA38d ASOUdB‘I Figure 6 TOTAL ANN UAL PRECIPITATION (in inches) SEE TABLE 2 20 support for the hypothesis that leprosy and high rainfall values are re- lated. A prevalent theory is that leprosy is a filth associated disease, and that once overcrowding, poverty, and unsanitary living conditions are removed, the leprosy rates tend to decline (Doull et. a1., 1936, p. 141). An interesting possibility is the theory that an insect may be the vector that transports Mycobacterium leprai. Such speculation results from two hypotheses: 1. If the portal entry is through the skin, an injury to the skin causing a break is a necessary prerequisite. Insect bites are a common cause of such skin breaks which may help to explain the higher leprosy prevalence rate in hot-moist climates (Doull, 1962, p. 52). Experimental evidence support an optimun growth temperature of M. leprae of 20° C. (68° F.) (Shepard, 1965, p. 1275.) 2. Fleas and lice may be possible vectors as they were reported to be prevalent in endemic areas on a world-wide basis (Dungal, 1960, pp. 25-34). Chapter II TUBERCULOSIS Tuberculosis caused by Mycobacterium tuberculosis is an infec- tious disease of man and animals and an important cause of death. There are five established varieties of the tubercule bacillus that cause simi- lar manifestations in man and animals. They are the bovine (M. bovis), the avian (M. avium), the human (M. tuberculosis), the murine (M. microti), and the piscine (M. marinum). Tuberculosis in humans is caused by the human and bovine varieties (Muschenheim, 1967, p. 259). The bovine and human varieties are able to infect animals and humans reciprocally, thus the primary reservoirs are cattle and man (May, 1958, p. 109). Infection occurs due to prolonged contact with infected individ— uals and consumption of unpasteurized milk. Most commonly infection takes place by entrance into the body of tiny droplets and sputum through the process of inhalation. Bloodstream and congenital infection are rare (Muschenheim, 1967, p. 261). When the tubercule bacillus enter the human body very little reaction is provoked. The bacilli remain extracellular and migrate by lymphatic channels to establish infection in the lymph nodes (Seabury, 1968, p. 183). When a potential human host encounters the bacillus, its natural defense may be adequate. If such is the case, the bacillus may be sealed off by the body's tissues creating a scar in which the bacillus is imprisoned. A chronic benign form will now be pre- sent which will react to skin tests. The host that contains the benign 21 22 form of tuberculosis may become infected from the bacillus in his own system erupting from the scar tissue (Heaf, 1967, p. 73). Tuberculosis may affect almost any tissue or organ of the body; the most common seats are the lungs and joints. Fatigue, anorexia, weight loss, malaise, fever, and night sweats are manifestations common to tuberculosis. These symptoms are common to many illnesses and, in the tropics, the people most afflicted are those who have never known really good health. Local symptoms of cough and abundant sputum indicate the pulmonary variety which accounts for 40% of all cases (Seabury, 1966, p. 187). For the above reasons, a combination of methods are used to diagnose tuberculosis. The skin test is common. Examination of sputum by a straining technique isolates the bacillus which are acid-fast. The final method is through the use of X-ray to detect scar tissue (Gordon, 1965, p. 252). Pattern of Tuberculosis Prevalence The history of tuberculosis is long and complex. In many parts of the world it has been reduced to very low levels. In other areas it is increasing in prevalence. Tuberculosis appears to be becoming a disease associated with the tropics for socio-economic reasons (Lauchner, 1959, p. 1). It would reason that the level of economic development, social mo- bility, and urbanization combine to play an important part in the spatial pattern of tuberculosis (Henschen, 1966, p. 101). Up to the end of the nineteenth century, tuberculosis bacillus was most prevalent along the coast of Africa. The subsequent development of large trading and industrial centers caused tuberculosis to be spread widely. Until the colonial era, the settlement pattern of Africa was 23 primarily that of small clans and ethnic groups which tended to minimize contacts over wide areas. Even though there were carriers of tuberculosis, widespread diffusion was not taking place. New concentrations of popula- tions occurred and inter-ethnic contact increased after the beginning of colonialism. In 1900, tuberculosis was nonexistent in the former Belgian Congo (Zaire), but in 1921, the number of cases was reported to be rapidly increasing (1900, no cases; 1915, 41 cases; 1921, 103 cases reported). Medical practitioners noted that there was usually an almost total absence of tuberculosis upon penetration. However, the disease attacked the Afri— can population at epidemic strength as the European presence increased (Roelsgaard et. al., 1964, pp. 459-463). Regional foci of tuberculosis in Africa could be hypothesized along the Guinea Coast of West Africa, the mineral rich zone of Central and, Southern Africa, the plateau country of East Africa, and the North African Coast. The West African Coast is a major dispersal point for tuberculosis into the less populated parts of the interior. The mining concerns and industrial development of Central and Southern Africa have attracted workers from a wide area. Recent and past shifts in population in the East African region have caused tuberculosis to become widespread in that part of Africa. TUberculosis has spread rapidly into some Saharan communities as a result of petroleum exploitation (Meyrney, 1960, p. 139). Although tuberculosis is a major health problem in Africa, detailed statistics pertaining to nationwide prevalence are lacking. Table 4 shows the latest infection percents in the populations of selected African nations. The high value of youthful infection is an indicator of the severity and the future scope of tuberculosis infection. Most of the high infection rates appear to be associated with the most rapidly developing areas of 24 Table 4.--Estimated Tuberculosis Infection in African Countries % Estimated Youtha Country Infectionb Sources Botswana 20 WHO Chronicle-1965 Burundi 39 Geser, et. a1:1966 Dahomey 32 Geser, et. a1.-1966 Gambia 11 WHO Chronicle-1965 Ghana 15 WHO Chronicle-1965 Ivory Coast 10 WHO Chronicle-1965 Kenya 10 WHO Chronicle—1965 Lesotho 11 WHO Chronicle-1965 Liberia 9 WHO Chronicle-1965 .,Libya 8 WHO Chronicle—1965 Malawi 5 WHO Chronicle-1965 Mauritania 16 WHO Chronicle-1965 Mozambique 7 WHO Chronicle-1965 Nigeria 24 WHO Chronicle-1965 Senegal 10 WHO Chronicle-1965 Sierra Leone 23 WHO Chronicle—1965 Somalia 31 WHO Chronicle-1965 Sudan 22 WHO Chronicle-1965 Swaziland 15 WHO Chronicle-1965 Tanzania 10 WHO Chronicle-1965 ,.Tunisia 12 WHO Chronicle-1965 Uganda 9 WHO Chronicle-1965 /,U.A.R. 22 WHO Chronicle-1965 Sources: Geser, A., Roy, L. A., and Bl¢cher, C. "Direct BCG Vaccination in Burundi, Dahomey, and Mauritania. A study of Local Complications," Bulletin of World Health Organiza- tion. Vol. 35, No. 4, 1966, pp. 609-632. "WHO Assisted Activities in Tuberculosis 1959-1964" WHO Chronicle. Vol. 19, No. 8, 1965, pp. 309—325. aYouth is defined as all those in the age group 0—15 years of age. bInfection is defined as those persons with positive tuberculin reactions as a result of vaccination. 25 settlement (Figure 7) and (Figure 12). The incidence of newly reported cases of tuberculosis offers an opportunity to discern possible hyper— endemic areas. As shown in Figure 8, the areas where economic devel- opment (urbanization, industrialization, etc.) is taking place have the high incidence of new cases. As a precaution it should be considered that the nature and sophistication of reporting techniques vary from country to country. An analysis of the spatial variation of case study rates provides further evidence of the regionalization of tuberculosis. The case study rates shown in Table 7 are ranked from highest to lowest. Upper quartile cases can be shown in Figure 9 as occurring in at least four distinct regions; the North African Coast, the Guinea Coast, the Lake Victoria area, and the Mineral Belt of Central and Southern Africa. 26 Table 5.--Newly Reported Cases of Tuberculosis in Africa 1966 and 19678 Rate per Reported million Country Casesb populationc Angola 3,298 441 Botswana 1,497 2,524 Burundi 1,985 601 Cameroon 1,164 215 Central African Rep. 601 427 Chad 1,666 485 Congo (Brazzaville) 799 929 Dahomey 396 158 Ethiopia 32,354* 1,367 F. Afars G Issas 958 11,827 Gabon 327 701 Gambia 633 1,861 Ivory Coast 2,337 584 Kenya 5,978 603 Lestho 1,661 1,887 Liberia 430 391 “'Libya 4,554 2,681 Malagasy Republic 4,028 623 Malawi 6,211 1,498 Mali 1,237 268 ——Mauritania 1,610* 1,504 Mozambique 1,575 221 Niger 823 222 Nigeria 9,203 149 Portugese Guinea 346 665 Senegal 3,539 983 South Africa 69,261 3,703 ~Spanish Sahara 310 5,082 —~Sudan 17,052* 1,681 Swaziland 1,298 3,547 Tanzania 19,413 1,509 Togo 433 260 .2United Arab Rep. 4,377* 215 Upper Volta 316 625 Zaire (Congo, K) 935* 58 Zambia 3,502 897 Zimbabwe (Rhodesia) 4,093 890 Source: World Health Statistics Annual, Vol. 2, 1966 and Vol. 2, 1967. aThose cases marked with an asterisk (*) are for the year 1966. bReported cases are those which have been documented or estimated by health officials. cRates per million were calculated by the author (MOT). 27 Table 6.--Ranked Tuberculosis Case Studies in Africa Number Location Estimated rate8 in of per million Fig. 9 Study Source population 1 Senegal Dakar Brunel, et. al.- 1967 229,000 2 Zambia Kitwe Gove-1967 126,000 3 Uganda Kampala Lloyd-1969b 125,000' 4 Zimbabwe (Rhodesia) Midlands Prov. Davies-1970 86,500 5 ,Tunisia Tunis Nyboe G Christensen- ’ 1966 65,000 6 Zambia Broken Hill Buchan-1967b 64,000 7 South Africa Transkei Shennan-1968 50,000 8 ,.Morocco Urban Shennan-1968 50,000 9 Sierra Leone Urban Shennan-1968 50,000 10 United Arab Rep.Urban Shennan-1968 45,000 11 Botswana Urban Shennan-1968 40,000 12 Upper Volta Rural Shennan-1968 40,000 13 Ghana Coastal village Koch-1960 30,000 14 South Africa Natal Shennan-1968 30,000 15 Swaziland Rural Shennan-1968 30,000 16 Uganda Kampala Kanti G Lwanga—197l 28,700 17 Lestho Rural Shennan-1968 20,000 18 Port. Guinea Rural Das Neves-1964 15,600 19 Tanzania Mwanza Radtke-1968 15,000 20 Zimbabwe (Rhodesia) Chikore Donaldson-1971 14,570 21 Zaire (Congo,) Luluaborg —-l957 10,800 22 Kenya Central Prov. Geser & Thorup-1967 10,000 23 Uganda Rural Geser G Thorup-1967 9,900 24 Gambia Urban Geser & Thorup-1967 8,000 25 Ethiopia Harar Blakos-l963 4,300 26 Ghana Forest Belt Koch—1960 3,000 27 Liberia Urban Geser & Th0rup—l967 3,000 28 Zimbabwe (Rhodesia) Bulawayo Doy-1970 900 29 Nigeria Igbo-Ora Wyatt G Matthew—1968 900 30 Kenya South Nyanza Grounds-1962 400 aData were standardized to rates per million by author (MOT). Case studies are not age specific except where indicated: those so marked are children only. 28 TUBERCULOSIS INFECTION I- 00‘ 4094 ~20 I 20°-I I. I - .4 I 90 ' po° I 0'4 I l I . PERCENT YOUTH INFECTION ~ (loss than I5 no") .WpI [3 PERCENT or TOTALINFECTION . 2&~ I I I 55 No DATA AVAILABLE I | (years of data voriu) I I Q I I .I . an 40« o 250 100 000 L SEE TABLE 4 MLES 20° 0° 20’ 46' 50° Figure 7 29 Id .« .< d .4 m w 0 0w w 0 w i S a Am a... .s. m 0 0.00, 1€000 _ .o _ 00000000000, _ .o I \ 0 0 0 0.0 o P _ 00000000000. I a . 000000 . I I. . 000000 0 D 000000000000000 0.0 000 mm. I 0 0 0 0 0 e 0 0 E 00000 00000 . 00000000000 000 00000 R.r AbbfihfififlfiflfifiZLTI.1 . O 6 0000000000000000 0 0 _ . P 9 0000000000 5. E I [00000000000000000 R .. 3.0 0000 V3 . L ..... O S 0 r2 WA ”4 EC N Fm... OS 0 . . EL .............. CU \' 0" NC I ER N O W m c 0% m m 4. 7 v I I 0 o CU NM 2.. . . o. WT PL r 9 9 w . m... m E E m a on A mm L NL M O I'h v 0 rm M H W A m. m 0 A 5 H L n E Y H VI 0 L R G w R B E I- o E o A v H L v N T I. A. E N m m r a a w .m .o w d I F b L h Figure 8 30 TUBERCULOSIS CASE STUDIES ”0' I97I-I957 40‘ l | L20. i 20°-4 ’0. 0.4 QUARTILE RANKING PER MILLION POPULATION *2u‘ ‘ VERY HIGH (229,000-50,000) 90-. I HIGH (50,000-28.700) . LOW (20,000-8.0m) 0 VERY LOW (4.300400) {5% pl”. 404 o '25—5'030— .00 SEE TABlE 6 MILES 210° 0' 20° 40° 50° Figure 9 31 Dynamics of Spreading Urbanization The transmission of tuberculosis is dependent upon man—to-man contact. As the potential host comes into contact with infected host, the transmission of tuberculosis may occur. In every tuberculosis sit- uation the size of an infector pool is of primary concern. However, the reservoir is not just active cases but also includes benign cases which may under situations of undetermined stress become active cases (May, 1958, pp. 110-111). The world pattern shows three factors which tend to determine in any given area the prevalence of tuberculosis: standard of living length of time the disease has been present population density In most of the African countries the pOpulation is primarily rural. Because of this and due to the length of time since tuberculosis becomes widespread, the amount of infection varies considerably between countries (Shennan, 1968, pp. 12-13). African cities are usually the centers of modernization. The resulting rapid growth has fostered a host of problems for the African urban community. One problem which has a direct bearing upon tuberculo— sis infection is overcrowding and unsanitary conditions. Lagos, in Western Nigeria is estimated to have grown from 267,000 in 1950 to 800,000 in 1970 (Davis, 1969, p. 165). An African scholar commented upon this fact: Demand for housing remains insatiable owing to a chronic shortage of housing finance. The result is overcrowding 32 and a rapid rate of property deterioration in nmst parts of Lagos. In the older parts of the city this has led to the creation of indescribably squalid slums (MabOgunje, 1969, p. 320). Due to the lack of refined data, a statistical test of the rela— tionship of tuberculosis prevalence to urbanization cannot be made. Visual examination of the data raises the speculation that some relationship exists. Figure 10 which shows urban centers with populations greater than 100,000 and Figures 7 and 8 which show infection rates and newly reported cases show a strong visual correlation of increasing urbanization with increasing tuberculosis infection. The work of a recent World Health Organization survey shows rural-urban comparisons in six African nations (Figure 11). In nearly all cases urban prevalence rates are higher than the corresponding rural rates (Roelsgaard, 1964, pp. 457-518). Migration The patterns of movement from the rural areas to the urban areas is shown in Figure 12. This movement is the result of both a poor agricul- tural base in the rural areas and the lure of a wage earning job in the city. Migration between rural and urban areas is only one component of the total migration phenomena. The economic develoPment of the African continent along Western lines has had a profound influence upon the dis- tribution of tuberculosis. Increasing industrialization has resulted in increased abandonment of the traditional way of life. The growth of urban centers near mineral-rich zones has provided for increased movements of peeple to towns. South Africa increased the total urban population by 33 >0. P20 “20' .5- arw 50' .o- 40‘ URBAN CENTERS WITH POPULATION GREATER THAN IO0,000 FROM: DAVIS, I969 L._ .A._.__ o 200 400 "LE .00 S 00‘ 20‘ .o-I 001 Figure 10 PERCENTAGE 34 ESTIMATED PREVALENCE OF TUBERCULOSIS INFECTION IN URBAN AND RURAL AREAS OF SIX COUNTRIES MALES FEMALE§ 20' URBAN AREA— RURAL AREA-u SIERRA LEONE 60> '010203040500 1020304050 AGE m YEARS SOURCE: ROELSGAARD of GI. I004 Figure 11 35 *‘O > CO. MAJOR MOVEMENTS OF MIGRANT LABOR DIRECTION OF LABOR MOVEMENTS AREAS OF ECONOMIC DEVELOPMENT anon Nance , "70 Profihoro, "03 ..... h—h—Ln——# 0 no co m 20’ o' 20' 00° 00' «AI 20" 20“ 0o: Figure 12 36 80% between 1936 and 1951. In Zimbabwe (Rhodesia) the African population of seven municipal areas increased from 248,000 to 324,700 during the years 1951 to 1956 (Oram, 1965, p. 12). The primary reason for this increase is migration of either a permanent or a temporary type. In Malawi, 27% of the grown men at any one time are estimated to be away working in Rhodesia and South Africa (Oram, 1965, p. 13). Two aspects of this migration to urban areas war- rant attention. The temporary migrant has one main objective: to work and save as much as possible in order to bring a lump sum of money home or to send regular remittances. Invariably they live at their place of work or nearby in unsanitary and crowded conditions. As most of these men are unmarried or without their wives, they develop poor nutritional habits. Thus, they make themselves susceptible to disease infections (Roelsgaard, et. al.,1964, p. 462). The second aspect is that the indi- vidual who becomes unable to work usually returns home. Tuberculosis then is transferred from the urban foci to the rural foci (Dormer, 1956, p. 52). The repatriated migrant worker represents a grave problem in all of Africa. Tuberculosis has been spread from the coastal cities inland to rural areas (Delamoras, 1960, p. 281). Investigations have shown that tuberculosis reached into the most remote areas of Zaire (Congo, K), brought by sick workers returning home. In Kenya, it was found that although the rate of infection was highest in Nairobi, the rate of active cases was much higher in the rural areas due to movements from the city at the onset of infection (Roengaard and Nyboe, 1961, p. 862). This fact is supported by the work of Haynes (1951, p. 67) who found in Kenya that high reactor rates and high disease rates indicate new introductions of the disease. 37 In 1955, a new source of infection into Malawi resulted from African workers returning home from South Africa and Rhodesia (Goodall, 1955, p. 48). A virtual epidemic of tuberculosis occurred in the upper part of the Zambezi from 1950 to 1960. It was thought that the development of new roads and the accompanying migration between northwestern Zambia and urban centers were to blame (Grave, 1962, p. 217). At El Golea, an oasis community in the Algerian Sahara, 70.1% of 12,000 inhabitants re- acted positively to tubercular tests. These high rates were attributed to the influx of oil prospectors (Meyrney, 1960, p. 139). The diffusion of tuberculosis is contingent upon three factors: (1) The Mycobacterium must be capable of persisting in a res— ervoir. In the poor living conditions of the urban centers this condition is easily met because of the continual migra— tion to the city. (2) A carrier is needed to move the mycobacterium about. The repatriated worker acts a carrier of the disease to infect the rural areas. (3) The environment must be favorable to increasing the virulence of the disease. The underexposed rural areas represent an excellent medium upon which tuberculosis can manifest itself (Siegfried, 1965, pp. 21-23). The urban center is seen as the primary di5persion point for tu- berculosis. The households of the infected migrant and his family function as secondary foci (Gordon, 1962, p. 43). It would appear that in the future the major tuberculosis problem in Africa will be a rural one (Figure 13). 38 URBAN PRIMARY FOCI INFECTED POTENTIAL HOST HOST RURAL SECONDARY FOCI I TRANSFER OF TUBERCULOSIS -URBAN TO RURAL Figure 13 Chapter III INTERRELATIONSHIPS OF LEPROSY AND TUBERCULOSIS Cross-Immunology It is usually accepted that a close relationship exists between leprosy and tuberculosis. The exact mechanism of the immunological re- lationship is not known, but it is thought that populations with a high prevalence of tuberculosis may have increased resistance to and hence a lower prevalence of leprosy (Grounds, 1964, p. 13). This may be due to the fact that both diseases are chronic and infectious. Tuberculosis is more infectious and spreads more rapidly in non-immune populations than does leprosy (Chaussinaud, 1953, p. 90). Thus, populations heavily in— fected with tuberculosis are said to be afforded some protection from leprosy which has a longer incubation period and slower spread. It seems probable from historical sources that leprosy preceded tuberculosis in most countries, and when introduced, tuberculosis spread initially in more densely populated areas. Thus, leprosy was ousted from all areas except the less pOpulated regions where it eventually may die out (Grounds, 1964, p. 13). Chaussinaud suggests that in EurOpe where tuberculosis was increas— ing leprosy was declining. The basis for this statement is that there are low rural tuberculosis rates and high rural leprosy rates. He states that in West and Central Africa, tuberculosis is rare, while leprosy shows active 39 4O foci. ”Civilization"4 by its development tends to spread tuberculosis while leprosy is caused to disappear (Chaussinaud, 1953, pp. 90-95). The foregoing conclusion needs clarification in that Chaussinaud does not dis- tinguish between specific regions of West and Central Africa. In West and Central Africa, the active leprosy foci are located away from urbanized areas. The relative para-immunity can be studied in relation to BCG vac- cinations in newborns where leprosy is highly endemic and where tuberculosis spreads only slightly. If the theory of antagonism between the two diseases is valid, subjects negative to tuberculosis and not vaccinated with BCG should furnish a relatively elevated proportion of leprosy cases, parti- cularly of the lepromatus type. Cases of leprosy in turn should appear more rarely and tend to be more of the tuberculoid type after a period of three years following revaccination. Further evidence of abortion of lep- rosy by tuberculosis can be shown by regions where leprosy has been spread only recently and where leprosy has declined. The tuberculosis index will be found to be low in countries where leprosy appeared recently or is very marked (Chaussinaud, 1964, pp. 82—84). The following is a study of the relationship between leprosy and tuberculosis in South Nyanza, Kenya conducted by Grounds. South Nyanza, is a rural district in the southwestern part of Kenya where leprosy and tuberculosis are common. The Luo inhabit the warm, dry lower lying part of the district and the Gusii live in the cooler, wetter, highlands. The Watende-Kuria who are Bantu pastoralists live on a grassy plateau in the south part of the district at an altitude and climate 4Chaussinaud is implying westernization. 41 midway between the other two areas. Most of the Kissii in the highlands live fairly close together in areas where the average family holdings are 2 to 3 acres. The lower lying country is less populated with the average holdings about 8 to 24 acres. The Kuria have large areas of grazing land and live in isolated homesteads. During 1955—59, work in the district showed that in the fairly densely populated Kissii highlands where leprosy was very rare, the pre- valence rate of tuberculosis was nearly twice that of the less populated areas among the Luo and Kuria where leprosy was common. Where leprosy did occur it could be seen that the numbers of tuberculosis patients were high and those of leprosy patients were low and vice versa. Table 7 shows the results of the survey. When the figures from columns 6 and 7 are plotted by log/log transformation, a linear relation- ship results as shown by Figure 13. The situation in the Kissii highlands is that leprosy is virtually non-existent. The clinics concerned are numbers 1 to 9. They are brack- eted as A in Figure 13. Clinic 22 drew its population from the border of Kissii and Luo country where the incidence of leprosy was very low (10 cases in 895 people examined). Clinics 14, 22, and 29 were included in section B of Figure 14 where adequate data collection was known to show a low register of tuberculosis due to staffing problems. If A and B sections are excluded, section C represents tuberculosis and leprosy from locations where both diseases exist and as far as possible have had equal attention by health officials. The coefficient of correlation for section C with 17 observations is -0.675 which is significant at about the .01 level. The conclusion is that in areas where leprosy occurs not infrequently, a percentage increase 42 Table 7.--The Prevalence of Known Cases of Leprosy and Tuberculosis in Proportion to the Population Served in Various Clinics in South Nyanza- November, 1959 Known Tuberculosis Leprosy Known Leprosy Serial Population on Live on Tuberculosis /1000 No. Clinic Served Register Register /1000 Served Served 1 Kisii 112,000 186 O 1.65 0 2 Keroka 28,000 40 1 1.43 0.04 3 Nyamache 29,000 9 O 0.31 0 4 Ogembe 34,000 52 0 1.53 0 5 Nduru 26,000 34 1 1.30 0.04 6 Tinga 24,000 25 O 1.04 0 7 Nyamira 14,000 18 0 1.28 0 8 Nyamia 24,000 26 0 1.08 0 9 Matongo 10,000 5 0 0.50 0 10 Kabondo 29,000 11 262 0.37 8.34 11 Oyugis 52,000 35 257 0.67 4.94 12 Wagwe 20,000 13 119 0.65 5.95 13 Homa Lime 20,000 19 106 0.95 5.30 14 Ndiru 29,000 4 287 0.14 9.89 15 Homa Bay 20,000 6 245 0.03 12.25 16 Mbita 21,000 3 341 0.14 16.23 17 Gwassi 14,000 13 57 0.93 4.01 18 Ndiwa 34,000 39 266 1.14 7.82 19 Marindi 21,000 11 164 0.52 7.81 20 Pala 11,000 7 65 0.63 5.91 21 Sare 31,000 31 236 1.00 7.61 22 Kamgambo 25,000 l7 14 0.68 0.56 23 Kehanca 14,000 12 20 0.85 1.43 24 Taranganya 14,000 44 21 3.15 1.50 25 Butende 10,000 23 34 2.30 3.04 26 Migori 22,000 32 54 1.45 2.45 27 Muhoru 4,000 l 65 0.25 16.25 28 Kadem 10,000 10 72 1.00 7.02 29 Karungu 19,000 4 27 0.21 1.42 Source: Grounds, J. G., "Leprosy and Tuberculosis, A Sta- tistical Relationship in South Nyanza, Kenya," Journal of Tr0pical Medicine and Hygiene. Vol. 67, No. l, 1964, pp. 13-15. 43 '00. .mozaomo ”wOKDOm Al's. wmzmx.<~z<>z 150m 2. w_m0.50mmm3h 024 >m0mam4 no Q_Im20_._. 3 P O p ---'34‘ A’,// E- o COLLEGE RD 4 Z anoa no, azvqmw Figure 1 T.6N. T.5N. TAN. T.3N. T.2N. T.I N. SURFACE GEOLOGY in parts of CLINTON and INGHAM COUNTIES MORAINES OUTWASH PLAINS [:1 TILL PLAINS PEI ESKERS :33 DRAINAGE CHANNELS -'° TOWNSHIP LINES SOURCE' R.IE. WINTERS the Portland, Ionia, and Grand Ledge moraines (Yarger and Cranson, 1970, p. 7). Immediately to the south of the Red Cedar River the esker is again recognized as a broad delta—like feature in Section 27, T4N, R2W, where it is crossed by Mount Hepe Road. From the Lansing moraine south for 3 miles, the esker lies in a clearly defined trough associated with Sycamore Creek. In Section 11, T3N, R2W, the esker trough and Sycamore Creek separate and remain distinct from each other for about 8 miles before rejoining in Mason (Section 5, T2N, RIW). From Mason southeast- ward for 3 miles the esker trough and Sycamore Creek are together only to separate again where the esker terminates in the Charlotte morainic system in Section 27, T2N, R1W. //” The purpose of this study is to treat the esker as an example of a [glacial landform undergoing change in and near an urban setting. To satisfy these goals, the study area was limited to a representative portion of the esker within the urban area. For these reasons, the area to be studied is within T4N, R2W (Lansing city) and T3N, RZW (Delhi Charter Township). (See Figure 1.) DISCUSSION Development of Sand and Gravel Extraction [._ I 5 Within the Lansing area the impact of man's activities upon the landscape is nowhere more vivid than that shown by the Mason Esker. The esker has been greatly altered primarily by the extraction of gravel and sand. The former position of the esker is generally marked by a series of linear ponds and excavations. The original esker ridge remains only in a few places and most of these appear destined for quarrying;,”' General extraction on a large scale was initiated about 60 years ago. The Lansing Tepographic Quadrangle of 1911 shows areas where quarrying was extensive enough to be mapped. Before this time the esker had minimal economic value to man because of a lack of demand for gravel to be used as aggregate. The initial increased demand for sand and gravel on a large scale resulted primarily from a need for more and better roads which was related to the increasing use of the automobile. By 1925, five of the 13 areas delimited in this study as quarries had been established. By 1940 this figure had increased to seven,and nine of the 13 areas were or had been in production by 1950 (Figure 3). During the 1910 to 1920 period the alteration of the esker was not one of continuous Operation at a site until the materials were depleted. Instead much of the removal was done intermittently by men shoveling directly from the slopes of the esker. When the material was quarried down to ground level, a new section of the esker was excavated. Later the widespread use of the steam shovel allowed many of these abandoned l"Quarrying" is a term often used for extraction of unconsolidated economic deposits as well as bedrock. It is used to describe removal of generally unconsolidated glacial drift of economic value in this study. DURATION OF OUARRYING If! T3N Sites being mind 24 as of I97l @ 0 25 O 30 f 31 R2W|RIW 1 I97I . 10 sites to be quarried to a lower level generally marked by the water table. A final phase of excavation involved the use of drag lines and dredges which made possible the removal of the sand and gravel below the ground water surface (personal communication with 0. Solomon of S. D. Solomon and Sons). Figure 4 represents the results of an earth resistivity survey conducted by the Michigan State Highway Department on the esker in the NE % of Section 14, T3N, RZW. Investigation of quarrying operations shows that the depth of the esker below ground level is nearly equal to its elevation above the general ground level. As a result of quarrying operations penetrating the water table, ponds now mark the former position of the esker. Selected Economic Aspects Analysis of the esker materials for use in highway projects indicate that the materials in the esker are of poor quality. Boring tests show that the composition of materials is primarily coarse sand with occasional local zones of finer texture materials (Figure 4). Negligible amounts of gravel were found at the site (Report of Resistivity and Boring Survey, 1964). Those who are involved in excavating the esker materials generally expect to find at least 70% sand. Most of the (sand is used as road £111 or general fill (personal communication with M. Miller, retired superintendent, Cheney Block Company, 1971). The demand for sand which comprises the bulk of the esker deposits has increased. In 1954, fill sand from the esker south of Holt was valued at approximately $0.04 per cubic yard. Presently raw material from the esker is valued at $0.10 to $0.30 per cubic yard. The present variation in price is due to location and quality of the material Faun ><3ro.r 240.10.! m0 ukflrm ”mezzom E can cot. com con 2:. co» oo~ oo. o ... m u... u o ... b a u o AJIJIIIIIIIIiIIIIIIJ I I l I I \ \I I I I I I I .\ \l I I I. I I ...I. ...... 2 «£36236 .L e e . i dz: 5:; mmHam“mweewe... ...... I 8 I. ......... .. m u z o N > s. < o ._ z e _ 3 a z < m . 8. 20: 6mm .2. mmomo mmxmm Figure 4 12 (personal communication with H. Ketchum, 1971). Another company engaged in sand and gravel excavation estimates that the value of the raw material (pit run), at about $0.05 per cubic yard in 1930, is presently priced at $0.20 per cubic yard (personal communication with E. Scarlett of Scarlett Gravel Company, 1971). Another excavator who deals primarily with fill sand estimates that in 1960 raw material (pit run)2 was valued at $0.10 per ton3 while the value has presently risen to $0.25 per ton in 1971. Labor cost contributes a major portion of the price of the material. When raw material which has a value of $0.25 per ton is loaded on a truck, the value rises to $0.75 per ton (personal communication with 0. Solomon of Solomon and Sons, Excavating, 1971). All those in the sand and gravel business contacted agreed that the rise in value of the materials is a function of increased demand combined with increased expenses for equipment and labor. In 1946, a 5 yard dump box truck cost approximately $1,600.00 while a comparable 5 yard dump box truck in 1971 cost approximately $6,300.00. Wages for truck drivers were $4.02 per hour in 1969 and have increased to $5.60 per hour in 1971 (personal communication with H. Ketchum, 1971). The value of the raw materials from the esker have increased as a result of three factors: increased demand, decreasing supplies, and increasing costs of production and processing. There appears to be concern among some of the various companies engaged in sand and gravel excavation not to deplete their resources too fast. As the amount of material declines in the Lansing area a sharp increase in price is expected (personal communication with B. Esterline 2Pit run is the unprocessed material as it lies in place in the esker. 3One ton equals about 1.5 cubic yards. 13 of Builders Hedi-Mix, 1971). As the demand for raw materials that are used in construction and general fill increases, the value of the raw material will also increase. Increased value of raw material will likely be reflected by the reworking of some of the quarries that have previously been abandoned and the hauling of raw materials from greater distances. Present Land-Use Patterns The analysis of present uses of the land may help provide a general basis for reference when predicting future land-use patterns. Present trends could well provide important information for future evaluation. For the purpose of this study, the land use associated with the esker was divided into the following groups: idle, mining, industrial, commercial,(iesidential) agricultural, transportation, andgpublic servicea) Public service: This group includes all public lands used by the federal, state, township, or city governments for providing social, cultural, and health needs. In this category are two cemeteries, Nbunt HOpe and Maple Ridge. Both of these features are of long duration and indicate that early settlers attached a special significance to the nature of the esker. Another public service usage is a land-fill project which occupies most of Section 2, T3N, RZW. At this time, the project is expected to be completed in the next three to four years. Public service land use illustrates two ways in which the esker has been of public service. In the case of the cemeteries the topography and well-drained character of the esker was a major consideration, while in the case of the public land fill, location of an excavated portion of the esker 14 within a major urban area was a major factor determining usage. The latter is a good example of sequential use of the esker site. Transportation: This grouping includes all existing street, highway, and railroad rights-Of-way. At various points the esker is crossed by county and city roadways and in one place by rail lines. The most significant portions occupied by transportation routes are parts of I-96'and Cedar Street. In Sections 24 and 25, T3N, R2W, Hogsback Road was built on the crest of the esker. After Cedar Street was constructed, Hogsback Road became less significant as a tranSportation route. This change of traffic flow has allowed Hogsback Road to be closed to through traffic. At the present time, active mining has removed much of the former route of the road and serves as another example of sequential use of the site. ,7, Residential: This includes the domiciles of families or household {units and the surrounding land normally used by the occupants of the household. Residential land is generally associated with well-drained soils. The Lansing Topographic Quadrangle of 1911 shows a pattern of housing preference on the esker as Opposed to the adjacent poorly drained soils. Part of the same pattern exists today. Homes built on the esker are most numerous in Holt where there is a well-defined residential area along Delhi, N.E., and Hill Street. Indications are that some of these houses were built as early as 1864 (personal communication with K. Lamereaux, 1971). In the areas adjacent to active mining the residential areas may be encroached upon by quarrying activities. An example of such a situation is in Section 25, T3N, R2W, where an excavating company owns most of the homes built along the flank of the esker and has removed one residence in the past two years in order to Obtain more sand and gravel. 15 a Commercial: These parcels of land have establishments which supply services and goods to the public. Commercial enterprises found in the study area include three lumber dealers, a golf driving range, a restaurant, an auto dealership, and a tire outlet. The esker itself provided little impetus for these Operations to come into being. Rather it was the need to occupy a site in close proximity and accessible to transportation arteries. Commercial land use of the esker site is expected to increase in the future.gf Industrial: Industrial land uses are those which are primarily engaged in processing, manufacturing, or assemblage of products. In the study area five such Operations are noted. All of them are aggregate plants and occur more or less equally spaced along the esker. When the raw material supplies are exhausted in the immediate vicinity of the plants, the site is then used to stockpile raw materials hauled to the area or for equipment storage. Mest of the operators state that when hauling concrete in redi-mix trucks or hot asphalt from the plants they would prefer to work within a 15 to 20 mile radius because of cost of operating the equipment. Mining: Lands classified in this category are those in which extractive processes involving earth materials are taking place. At the present time three sand and gravel quarries are in operation. The major locational factor is Obviously the availability of materials. At the present time remaining supplies of sand and gravel are scarce and production practices tend to indicate this awareness. Solomon and Sons, Excavators could not give an exact estimate of how long their material would last because of uncertain economic conditions. However, they did conjecture that all of their material could be removed in less than one 16 year by concentrated activity. Builders Redi-Mix estimates that they have approximately 300,000 yards of sand that can be used for fill. The duration of this material supply was not known because production was being held constant in lieu of higher prices for the raw material. Scarlett Gravel Company officials estimate that they remove approximately 160,000 tons per year at their location south of Holt. The raw materials at that site are expected to last about six years at present excavation rates. Idle: All land that is vacant or underdeveloped is included within this category. Idle land comprises the most extensive land use associated with the esker. The land in this group can be subdivided into areas of abandoned quarry operations“ and areas of the remaining esker. As a result of excavations, linear ponds with zones of spoil occur along the trend of the esker. Only a limited portion of the esker remains undeveloped. The majority of the undeveloped esker occurs south of Holt along the east side of Cedar Street in Section 25, T3N, RZW. The land classified as idle represents an important group because it is anticipated that most of the future land-use changes on the esker site will take place on these parcels of land. Agricultural: Land used primarily for the production of plants and animals for commercial purposes is termed agricultural. On the portion of the esker in the study area there is no land that fits this description at the present time. The closest approximation to agricultural land occurs in Section 11, T3N, R2W, where a plot of land is used as a pasture for horses. The lack of crop land found on the This group also includes a plot of land that is quasi—agricultural, in the sense that it is used as a pasture for horses for various lengths of time. 17 esker is directly related to the steep slopes and droughtiness of the soil. In Ingham County eskers were mapped primarily as Bellfontaine 5 loamy sand and described as having "only small value for general farming" (Ingham County Soil Survey, 1941, p. 21). In the study area agricultural land appears as a very poor competitor and has been replaced by more profitable uses (Figure 5). Findings and Results The land-use patterns associated with the esker can be analyzed both temporally and Spatially. Public service land uses have an average age of 99 years and are located within and near the southern margin of Lansing's corporate boundaries. Residential land uses have an average age of 57 years and occur in two clusters, one in the southeastern part of Lansing and the other around the Holt area. These two uses utilize the esker site rather than the raw materials and have been able to endure for the longest time period of any of the other categories. Mining Operations average 47 years in existence at the three sites although extraction processes have been identified at 13 locations in the study area. The largest portion of the esker that remains for potential extraction totals approximately 3,100 feet south of Holt along Cedar Street. There has been considerable variation in the duration of mining at a particular site ranging from 60 years to two years. As expected there was a definite trend for sites to be opened at more recent dates as distance from.the Lansing urban area increased (Figure 6). 5Bellfontaine has now been replaced by the name Boyer-Spinks on soils maps being constructed by the Soil Conservation Service. l8 4371 PRESENT LAND USE COMMERCIAL INDUSTRIAL RE$DENTIAL TRANSPORTATION MININCS IDLE PUBLIC SERVICE EEEDDWE Figure 5 l9 DURATION OF PRESENT LAND USES NORTH m E E E I C L L m T m IL L V A V WA A .AIL A R MT LR El N CA I E IR AE SN N RR R RP R CE GE ET E CGTS TC ID N0 M8 M .ILNSN su LIEIIEMUEMEBIU AEEUBE BSLNSLODLOLUND RLLD L UE E Pme UD RWCWwCDPMmemeI _ N O T LLLL L L L MAAAMMA M N. ”ML M HmCHTIC T C MUM T EEEEEflE rDLGE SET M S mMMmm MEImMENMUEEI SWWAADWLANWLAWDLLS E I R E RCCRRmaRMchCmeR SOUTH o u - - ......l- o 9 o E "S R «a oY 5 6 w m we ...... m H ..W o 20 Industrial land uses have the next highest average duration with a mean age of 19 years. The occurrence of the five nearly equally spaced aggregate plants follows the development of mining activities because they were initially concerned with processing of the raw materials from the esker. Due to exhausted supplies none of the plants process any material from their respective sites. Commercial land uses have a mean duration of 15 years. The spatial pattern of these activities are found in two clusters, one within and near the southeast portion Of Lansing and the other cluster in Holt. The commercial uses occupy altered or reclaimed portions of the esker. The low mean age may indicate that commercial activities may be increasing as urbanization encroaches. The land-use category which has the lowest mean age of duration is that of idle land. Idle land averages six years in existence and is found throughout the study area in a random pattern. There is no discernible pattern of land being left idle for shorter periods of time within the urban areas, as might be expected. or the 38 sites identified, 25 (68%) have been established in the last 25 years. Only seven (18%) are older than 50 years. Future Land-Use Trends Future land-use trends will probably be dominated by recreational and commercial activities while other groups such as residential, industrial, agricultural, transportation, public service, idle, and mining are not expected to increase significantly, if at all.i The advantages that recreational and commercial land uses have over the other categories will be examined in a regional context. 21 Commercial: This category will be expected to increase primarily as a function of the site location being able to produce high economic returns. An example of such a situation is the portion of the esker that lies in Sections 23, 24, and 25, T3N, RZW. In these sections the esker is near Cedar Street on its west side and adjacent to idle land on the east. Township officials have designated this one of the most attractive sites for commercial or industrial develOpment in Ingham County (personal communication with M. Dixon, Administrative Assistant to Supervisor, Delhi Township, 1971). The location involved amounts to 684.5 acres of former farm land that lies within one-quarter mile of an interchange with US 127, 2 miles from I-96, and is bisected by the Penn Central Railroad.6 Locational characteristics such as these make the site very attractive for develOpment. Recreational: It is expected that recreational land use will probably become the dominant land-use type to evolve on that portion of the esker in the study area. Future recreation development is perhaps best put into perspective by Clawson, who states that, in terms of numbers of people affected, recreation as a major land use is exceeded only by urban uses. He lists some major considerations that are increasing the demands for outdoor recreation. These are population increase, greater per capita income, shortening of the work week, and improved tran5portation facilities (Clawson, 1963, p. 54). The Ownership of most of this type of land will be by township and city governments. 6The land involved is shown in the Ingham.County Plat Book (1970) as being owned by D. Holloway and by the Holloway Construction Company, Incorporated of Wixom, Michigan. 22 The preponderance of recreational land use associated with the esker is primarily a function of political constraints. The contemporary awareness of and demand for outdoor recreational facilities have produced a situation conducive to the development of additional facilities?‘ In Delhi Charter Township it is expected that the recreational needs will approximate 5.5 acres per 1000 population by 1985. The officials are investigating the potential for public and/or private development of gravel pits for community recreational facilities (Comprehensive Develop— ment Plan - Delhi Charter Township, 1967, pp. 19-20). At the present time township officials are negotiating to purchase an abandoned gravel pit area in the NE% of Section 14, T4N, RZW for park development (personal communication with M. Dixon, Administrative Assistant to Supervisor, Delhi Charter Township, 1971). A second factor which increases the recreational potential of the land is the nature of the soils. The soils of the esker are well drained and porous, but the adjacent soils in associated troughs are often poorly drained (Soil Survey, Ingham County, 1941, p. 27). (See Figure 7) An example of limitation due to soil characteristics is shown in the pripg Ordinance pleelhi Charter Township, 1968. Section 6.6 Flood Plain Regulations reads as follows: 6.6.1 Intent and Purpose: The purpose of these regulations is to protect those areas of the township which are subject to predictable flooding in the flood plains areas of major rivers, their branches and tributaries within the township so that the reservoir capacity shall not be reduced thereby creating danger to areas previously not so endangered in the time of high water, or to impede, retard, accelerate or change direction of flow or carrying capacity of the river valley or to otherwise increase the possibility of flooding. 23 ~05 4u><¢0 mo ......auo III 6:63: 2.00264 I I. I\ p LT wo .000 IN“! con an. o COEEOO mficmflztom I .3526 age 2:630 / n F L mommm 0.1.00... n_<_hzmo_mum ..(20 ..r4mmowm ezmmmmd dfThese rapid transformations and the youthfulness of the land uses on the esker site, are primarily a function of man's decisions, which are the result of technological advances and social change. On the basis of this analysis meaningful predictions can be made about future land—use patterns and the associated extraction processes. :fFuture land-use will probably be dominated by outdoor recreational facilities which are motivated in part by perceived social benefits and appears to be evolving into a compatible relationship with the nearby urban area. It is further expected that there will be a decline in heavy industrial land use characterized by the aggregate plants. The lack of nearby raw materials, pollution of the air, and the semi-portable nature of the processing plants should allow for this decline.{ Finally a systematic plan should be deve10ped to utilize abandoned quarries as they become available in order to keep pace with the eXpansion of the urban area and to reduce potential hazards to lifeg‘ Although this study has dealt with only a portion of a geomorphic feature, it is believed that trends and processes which were identified will have application in similar situations. 29 SELECTED BIBLIOGRAPHY Books IClawson, Marion. 1961. ”Potential Demand for Non-farm Products and Services Provided by Agricultural Lands", Dynamics of Land Use: Needeg Adjustments. Chairman, E. O. Heady, Iowa State University Press. Embleton, C. and King, C. A. M. 1968. Glacial and Periglacial Geomorphology. New York: St. Martins Press. } Flint, R.JE 1970. Glacial and Quaternary Geology. New York: John 'Wiley and Sons Inc. Harvey, D. 1969. Egplanation in Geography. New York: St. Martins Press. Putnam, Wm. 1964. Geology. New York: Oxford University Press. Regan, M. M. and Wooten, H. 1963. "Land Use Trends and Urbanization," A Elage to Live, The Xearbook of Agrieultpre. washington, D. C.: The United States Department Of Agriculture. Strahler, A. 1960. Physical Geography. New York: 'Wiley and Sons. Journal Articles Barlowe, R. 1958. "Minimizing Adverse Effects of Major Shifts in Land Use," Journal 9f Farm Economics, 40: 1339-1349. 2 Flint, R. F. 1928. "Eskers and Crevasse Fillings" Americangournal of Science, 15 : 410-416. Grano, Olavi. 1959. "The vesso Esker in Southern Finland and its Economic Importance" Eepni . 82: 1-33. Sproule, J. C. 1939. ”The Pleistocene Geology of the Cree Lake Region Saskatchewan" qual Soc. Canada, Trans. 33: 101-109. weester, L. C. 1884. "Kames Near Lansing, Michigan" Science 3: 4. 3O 31 Maps Ingham County Plat Book. 1970. Rockford: Rockford Map Publishers Inc. Lansing Quadrangle. 1911. U.S. Geological Survey Topographic Map. Scale 1:62,500. Martin, H. M. 1955. Map of Surface Formation of the Southern Peninsula of Michigan, Michigan Geological Survey Publication #49, part 1. Scale 1:500,000. Topographic Map of Ingham and Livingston Counties. 1859. Philadelphia: Geil, Harley and Siverd. (wall Map). Scale l:78,125. Winters, H. A. 1970. Surface Formations of Clinton and Ingham Counties. Unpublished maps, Michigan State University, Department of Geography. Series Alden, W} C. 1924. ”The Physical Features Of Central Massachusetts" U_S. Geglggigal Survey Bulletin 760: 13-105. Crosby, W. O. 1902. ”The Origin of Eskers" Bogton Sogiety of Natural HAW 30: 375-411. Davis, W. M. 1893. "Sub—glacial Origin of Eskers" Beaten Sogiety Qfl Natural Histgry Proceedings. 25: 477-499. Douglas, C. C. 1839. Seggnd_Apnpal_B§pgrt. First Michigan Geological Survey. ~. Leavitt, H. W. and Perkins, E. H. 1935. ”Glacial Geology of Maine" Epine Tech. Report Expt. Sta; Bulletin,#30. 2: 232. . Leverett, F. and Taylor. 1915. "The Pleistocene of Indiana and Michigan" U.S. Geological Survey MOnogram. 53: 316-518. Theses Erickson, R. L. 1948. "A Petrograhpical Investigation of the Longitudinal Deposition within the Mason Esker Relative to Origin" Michigan State University. M.S. Thesis in Geology. MOCallum, M. L. 1949. "A Petrographic Investigation of Vertical Deposition within the Mason Esker Relative to Its Origin" Michigan State University M.S. Thesis in Geology. Other Material Comprehensive Development Plan - Delhi Charter Township, 1967. 32 Engineering Interpretations. 1965. Soil Conservation Service, U.S. Department of Agriculture. Ingham County Soil Survey. 1941. Series 1933, #36, U.S. Department of Agriculture. Report of Resistivity and Boring Survey. 1964. Highway Department, State of Michigan. Yarger, R. D. and Cranson, K. R. 1971. Field Guide to the Mason Esker. Lansing Community College unpublished paper. Zoning Ordinance of Delhi Charter Township, 1968. I’IICHIGRN STQTE UNIV. LIBRQRIES ? II IIIIIII II II I“ II (I .II 31293102759663