PUBLIC RECORD OFFICE
J
Reference :-
C.O.885
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19 PUBLIC RECORD OFFICE, LONDON
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show that in some cases the trypanosomes become accustomed to the drug and unaffected by subsequent doses. The uncertainty of the action of our present supply of atoxyl, however, very naturally makes our medical officers chary about using it in large doses.
The administration of atoxyl combined with strychnipe and judicious feeding has been attended over and over again with most astonishing results. Patients, who on admission have seem moribund, have several times been up and walking in a few days. This improvement is, unfortunately, only temporary, and no doubt the better feeding and the strychnine have much to do with it.
ATOXYL FOLLOWED BY MERCURY.
It is only lately that this treatment has been instituted, and it is, of course, too early to judge of results.
The native, as a rule, stands mercury badly by the mouth.
On the suggestion of Colonel Lambkin, Royal Army Medical Corps, we shall try the administration of metallic mercury following on a course of atoxyl as soon as ever this special preparation can be obtained.
SODIUM AMINO PHENYL-ARSINATE. (Burroughs and Wellcome.)
A small supply of this drug, sent to us by the makers, has been tried by Dr. van Someren, who reports favourably upon it, and says that trypanosomes have not yet returned to the glands of those few people to whom he has administered it, and that it seems as good as atoxyl. A further supply has been sent for from the makers, As this preparation is only half the price of atoxyl, it is certainly worth a more extended trial, especially as there seems to be a good deal of uncertainty in the action of our present supply of the latter.
LUNATICS.
As sleeping sickness is accompanied by grave pathological changes in the brain and nervous system, it is not surprising that many patients suffer from attacks of
mania.
The average advanced case is a harmless imbecile, but violent mania is some- times seen. Sixty-one patients in all have had to be isolated and restrained in our various camps. Each of our camps is now provided with a special lunatic annexe to which violent cases can be sent. Our camp buildings are, of course, only roofed with dried grass; on two occasions lunatics have succeeded in setting fire to the camps, and have done a great deal of damage. Native warders are in charge of them both day and night." Violent patients are handcuffed, but there is always the danger that some patient may become suddenly maniacal, and burn down the whole
camp.
On the whole treatment has been very successful with these maniacal patients, and prolonged restraint is hardly ever necessary.
All our medical officers report on the frequency of epileptiform fits. Patients soon die after these fits have once commenced.
SMALL-POX.
Small-pox being common in so many parts of Uganda, and the natives being practically unprotected by vaccination, it is surprising that so few cases have occurred in our camps. A bad case of confluent small-pox occurred at Kyetume Camp, in Kyagwe, but prompt measures of isolation were taken, and vaccine lymph telegraphed for at once from the Government vaccine farm, Nairobi, and obtained in four days. so that an outbreak was avoided. Vaccine lymph cannot be kept at a camp in good condition owing to the absence of ice.
CHIGGERS.
Chiggers are the pests of our camps. Every advanced case of sleeping sickness that is admitted swarms with them, and they multiply with fearful rapidity. In a bad case of sleeping sickness, the chiggers are not confined to the feet; the hands are often a mass of them, mouth, nose, and cars get infected in turn, and the result is a truly revolting spectacle.
A special large hut has been built, to which all cases go once a week, and their chiggers are there removed by native attendants, four of whom at each camp are
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kept constantly employed doing nothing else. By the use of large quantities of "Jeyes fluid," and by constant sweeping, these parasites are kept in some sort of check.
LICE.
Lice are also very common, and to preserve anything like cleanliness a large staff of native attendants is essential. The average native is quite convinced that sleeping sickness is a contagious disease, and it is difficult to get the attendants to do much for the very sick. This difficulty has been partly got over by employing as hospital attendants patients in an early stage of the disease. Towards the end, When coma as the bladder and rectum become paralysed, bed-sores are the rule. sets in, the patients are removed from the wards, and put into separate huts or compartments of a large hut. This is done in order that the other patients in the ward may not be constantly confronted by the dying, and for the sake of general hygiene. The small huts can be afterwards destroyed. and new ones built at å trifling cost.
FOOD SUPPLY.
An unfortunate drought has made the problem of keeping our camps properly supplied with food sometimes a difficult one. Clearing and planting is going forward now that the rains have started, but it will be some time before any camp will be able to supply its own needs. The Muganda prefers bananas to anything else and it takes more than a year to get a satisfactory crop, counting the time spent in first clearing the ground. Sweet potatoes give a crop in four months and these are being planted as fast as possiole; they have the additional advantage of requiring practically no attention when once the cuttings have taken root. Banana suckers are also being planted, but not to the same extent as potatoes; the former require more or less constant attention, the labours of one individual being only A new camp must sufficient to supply himself and two others with this food. therefore depend on outside sources for its food supply for many months. We have had to employ outside labour to a large extent for our clearing and planting. Many of the patients are quite capable of doing a little work, but they generally refuse; their excuse is that they are going to die and that they are not going to plant food for others to eat. A certain amount of work has been done by healthy relations who have accompanied patients to camp, but the presence of such relatives is the exception rather than the rule, the latter much preferring to just leave the sick one and then disappear as fast as possible.
Patients, when they first come to camp, generally have a little money, but this is soon exhausted and then they have to be fed at Government expense. The knowledge that free food can be obtained at our camps generally makes patients on their arrival represent themselves as destitute, even if they have a little money, A suggestion and it is practically impossible to prove the truth of their statements. has been made to the native parliament that all patients coming to camps for treatment should bring a letter from their local chief stating whether the bearer is actually destitute or otherwise, but nothing has so far come of this. It will not be long before every patient in our camp will have to be fed at Government expense. The present cost to the Government of buying food works out at one shilling per head per month; this, however, does not include the cost of bringing the food to the camp. Labour for this is supplied by the local chiefs and food especially the case at our camp at often has to be brought long distances; this Busiro, which has already consumed all the food in its immediate neighbourhood.
A native bed, barkcloths, cooking pots, and sometimes a blanket have also to Le provided for a destitute patient.
Meat in small quantities, milk, and native Lutter are provided for the very sick, which are either bought by Government or else presented by the chiefs, who have on many occasions been very generous in this respect. One bullock a month in addition is killed at each camp. The native is very fond of meat, and it was A certain number hoped that this would help to attract patients for treatment.
of people come to our camps representing themselves as having sleeping sickness or who have been so informed by relatives or others who do not want the trouble of looking after them, when they have not really got sleeping sickness or any symptoms of it. As a rule, these people are old and past work or else suffering from some disease other than sleeping sickness, and, in any case, are a burden to them- selves and their relatives and they have heard or been told that they will be given
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