PUBLIC RECORD OFFICE
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C.O.885
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Glands in neck not palpable. Cheeks are œdematous, pitting on pressure.
Case No. 43-July 27th. Ihungu. Man, æt. 40-45; ill four months; uses a stick; pain in back (described as "broken"), hips and thighs; loss of strength.
Legs. Marked œdema over tibiæ; no tenderness; knee jerk obtained slightly. No other symptoms.
Urine-No albumen.
Comments on Symptoms.
Muscular tenderness was extreme in some cases, less so in others. My practice was to squeeze the muscles tightly, and to watch the patient's face.
Urine. It would have been well to test other specimens; there is, however, no reason to think that albumen would have been found.
Fever.-A temperature of about 100° was a common feature when muscular tenderness was marked. I took blood smears of some of these cases. (Duplicates forwarded.)
Edema. Firm pressure was sometimes needed to demonstrate this. I have noted ædema of the face in two cases. The face appeared full in others, but it was impossible to be sure that the apparent fullness was of an oedematous nature.
Internal Organs.—I did not examine the state of viscera other than the heart. Mental Condition.-All the patients were active in mind; some of the worst sufferers made jokes that were more than passable judging from the effect on the bystanders.
Lymphatic Glands.-I palpated for glands as a matter of routine. The ratio of palpable to non-palpable glands in these cases is about what I find usual in
Toro.
Weakness.-This was complained of by all, but taken so much as a matter of course that they usually did not mention it till questioned.
Pulsation in Neck.-Usually most evident just to the right of the suprasternal notch under the tendon of insertion of the sternomastoid muscle.
To tabulate certain symptoms, of 25 cases here recorded-
12 had more or less ædema.
13 had marked tenderness of muscle, in some cases extreme.
18 no patellar reflex could be elicited, in 4 it was slight, in 1 normal, and
1 increased (Case 25).
18 had cardiac symptoms, and in 7 of these a bruit was heard with the
stethoscope.
Influence of Sex and Age. Of these cases 12 were men, 10 women, and 3 children. It is probable that all are attacked alike.
Progress of Mortality-Many of the cases were of long duration if the periods given were correct these were usually a multiple of the season (six months). Some acknowledged that they were better than they had been.
I was told at-
Kikumu that 4 deaths had occurred.
Kyegayuki that I death had occurred,
Karwenyu and Izina that 7 deaths had occurred.
Of the seven, each was mentioned to me by name, and some of his history given,
so that the figures may be taken as fairly correct.
Climatic Conditions.-At the time of my visit the grass was just burned or about to be burned; rain had not fallen at all in July. The dry weather might account for the scarcity of severe cases (if the disease be beri-beri). The majority of the sick were able to walk to my camp.
Housing Conditions.-I examined several huts but found nothing noteworthy. The houses are not built among the bananas as with the Baganda. They are
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placed simply at or near the top of hills, and any kind of fence is rare. If a man dies in a house a new one is built and the old one suffered to drop to pieces:-
Case No. 9 lived in a small undivided hut with two other persons, all slept
on mats on the ground.
Case No. 10 shared a house with seven persons, all slept on raised beds. Case No. 11 shared a house with five persons, all slept on raised beds. Case No. 12 shared a house with six persons, some slept on the ground, others
on raised beds.
Case No. 13 shared a house with seven persons.
Cases Nos. 15, 36, and 37 shared a house with two others, this had a back-
door.
Cases Nos. 23, 24, and 25 lived in one house, nine persons in all. A large
hut with a second door. Cases Nos. 30 and 31 lived in one house, six persons in all, beds on the ground.
A very dirty house, fowls and goats taking up much of the space. Cases Nos. 6 and 8 came from one house.
The huts are similar to those of all African negroes with whom I am acquainted; I fancy the Baganda keep their houses cleaner.
The huts are roomy. One of the largest I estimate to be 25-30 feet in diameter. The light is in most cases dim and the sun never penetrates.
The accompanying sketch shows the usual arrangement:-
D. Door. S. Screen, usually of reeds, mudded, or not. L. Sleeping room.
are often hung between the beds.
Bark-cloth curtains
Nature of Country.-Hilly, with great boulders on some of the hill-tops. Grass of a short variety.
Food.-Plentiful and consists chiefly of sweet potatoes, but bananas were also brought to my camp.
Water-Is obtained from shallow wells in the valley at Karwenyu, Izina, Kyegayuki, and Kasinga; from a swamp at Kikumu.
Biting Flies--A few Haematopota were caught at Kikumu. No biting flies elsewhere. Mosquitoes few.
Conclusions and Remarks.
The disease appears to me to be indistinguishable from beri-beri. I give this opinion with diffidence because I have not seen cases of beri-beri, and rely only on the brief description given in Manson's "Tropical Diseases."
I think it probable that the disease has reached Toro from Ankole, and antici- pate that it will spread to the Kingdom of Uganda, if it has not done so already.
Assuming that it is beri-beri it would be well to instruct the chiefs to burn houses the inhabitants of which are infected, and to lodge the sick in small huts by themselves, or with one attendant. That it is the houses that become infected one may reasonably assume, and it will be noted that in four houses I found more than one affected person. A more prolonged enquiry would perhaps bring this fact into greater prominence.
At Karwenyu a good proportion of the population, perhaps as many as 1-4, were suffering from a more or less severe form of the disease.
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