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134
No. V.
REPORT ON A CASE OF FACIAL PARALYSIS FOLLOWING SPIRILLUM FEVER. By Dr. W. A. DENSHAM, M. O., Nimule.
Signaller Deomall, aged 30,,Indian. Left Entebbe in November for Hoima, en route to Nimule, and slept in rest camps along the road. Fever commenced when nearing Hoima, where blood examinations were made by Dr. Bagshawe, who found spirilla. Patient states he had fever seven times since his first attack, and on each occasion it lasted three to four days, with two or three days interval. His health in Entebbe was good. The last attack of fever occurred on December 16th-18th just as he reached Nimule.
December 27th-Patient presented himself giving the above history, and com- plaining of difficulty in eating.
On examination the face is flattened on the right side, the eyelids cannot be closed, the left angle of the mouth is drawn over, and food collects in the cheek. The tongue is protruded in the middle line; sense of taste is not interfered with, and the palate moves well. The pupils are equal and small, neither react well to light.
The patient's general condition is good, and there is no other paralysis. January 3rd, 1906. The paralysis is now bilateral and complete. All expres- sion is entirely lost, and skin folds obliterated.
The voice is nasal, but the palate moves well, and there is no regurgitation of food.
Mastication is difficult, and the patient states that swallowing is effected by the aid of the finger.
January 6th-Patient complains in an indefinite way that his sight is failing. Pupils as before described.
January 10th-His condition is the same. but the sight is now all right. January 15th. The voice is less nasal. The left naso-labial fold is evident, and the paralysis appears to be clearing up.
The treatment adopted was a simple tonic of iron, arsenic, and strychnine. the patient attending to his usual work.
Similar cases of paralysis following spirillum fever have been observed, but a bi-lateral affection is, I think, uncommon.
What is the nature of the lesion in these cases? It is obviously peripheral not central, and is not likely to be a toxic affection of the nerve such as occurs in diphtheria. Exposure to cold is followed by a facial paralysis said to be due to a neuritis in the fallopian tube. These post-spirillar fever cases can hardly be explained satisfactorily in this way. Can the loss of function be due to a mechanical cause, e.g., temporary obstruction to the blood supply of the nerve by spirilla?
7154
No. 65.
THE LIVERPOOL SCHOOL OF TROPICAL MEDICINE to COLONIAL OFFICE.
SIR,
(Received February 25, 1907.)
[Copy to Acting Commissioners, East Africa, Uganda, and British_Central Africa Protectorates, March 8, 1907. Nos. 134, 65, and 83. L.F.],
[Answered by No. 67.]
B 10, Exchange Buildings, Liverpool, February 23, 1907. Expeditions of the Liverpool School of Tropical Medicine.
WITH further reference to your letter of the 28th December, No. 46610/1906,* in which it is stated that a sum of £1,250 will be provided from Government funds for the Sleeping Sickness and Blackwater Fever Expeditions of the Liverpool School of Tropical Medicine, on the understanding that at least an equivalent amount is provided by the School, I have to say that the Committee of the School have much
No. 213 in Miscellaneous No. 178.
135
pleasure in undertaking to expend an equivalent amount on these expeditions to that expended by the Government.
I have not been able to answer your letter carlier, as the question of the probable cost of the expeditions has depended to a certain extent on the selection of their personnel.
This is now practically settled, and I hope shortly to be able to furnish full particulars of the arrangements for the two expeditions, for the information and approval of the Secretary of State for the Colonics.
With reference to the third paragraph in your letter,* I have to inform you that the British South Africa Company have consented to offer the doctors of the Sleeping Sickness Expedition 10s. subsistence allowance per diem cach, free transport, and, where possible, free quarters. This offer is to hold good for the duration of one year after the expedition enters Rhodesian territory.
7154
No. 66.
I am, &c.,
A. II. MILNE.
COLONIAL OFFICE to CROWN AGENTS.
[Copy to Acting Commissioners, East Africa, Uganda, and British Central Africa Protectorates, Nos. 134, 65, and 83, March 8, 1907. L.F.] GENTLEMEN,
Downing Street, March 5, 1907. I AM directed by the Earl of Elgin to inform you that arrangements are being made by the Liverpool School of Tropical Medicine to send out shortly an expedition to the British Central Africa Protectorate for the purpose of studying blackwater fever, and that it has been decided that a contribution of £750 shall be made in equal thirds by the Governments of the East Africa, Uganda, and British Central Africa Protectorates towards the expenses of this expedition.
I am to request that you will pay over the sum of £500 to the School of Tropical Medicine from East Africa funds as soon as possible, charging this amount to the vote for the Joint Medical Department of the East Africa and Uganda Protectorates; the contribution of £250 from the British Central Africa Protectorate will not be available until the 1st of April next, as it has been placed on the estimates for 1907-8, and the Liverpool School of Tropical Medicine has been informed that it will be paid over to them on application being made at any time after that date.
I am, &c.,
7154
SIR,
No. 67.
H. W. JUST.
COLONIAL OFFICE to THE LIVERPOOL SCHOOL OF TROPICAL MEDICINE. [Copy to Acting Commissioners, East Africa, Uganda, and British Central Africa Protectorates, Nos. 134, 65, and 83, March 8, 1907. L.F.] [Answered by No. 68,]
Downing Street, March 5, 1907.
I AM directed by the Earl of Elgin to acknowledge the receipt of your letter of the 23rd of February stating that the Liverpool School of Tropical Medicine
is prepared to spend a similar amount to that provided from Government funds (viz., £750) on an expedition to study blackwater fever, working in conjunction with that which is to engage in the investigation of sleeping sickness.
2. Lord Elgin has now instructed the Crown Agents for the Colonies to pay
to you the sum of £500 (being the contribution from the Governments of the East Africa and Uganda Protectorates) on account of the Blackwater Fever Expedition; the further contribution of £250 from the Government of the British Central Africa Protectorate will be paid to you by the Crown Agents on application being made at any time after the 1st of April next.
No. 213 in Miscellaneous No. 178.
† No. 65.