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C.O.885
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Wellcome) to give it a proper trial, but a consignment of the drug has just arrived, and a certain number of patients will be systematically treated with it.
In a certain number of cases, patients who have been treated with atoxyl have developed symptoms suggestive of intoxication.
These cases are given in detail in the attached table, which shows the amount of It is true atoxyl received by each case before the symptoms described were noticed. Giddiness has been by far the commonest symptom complained of. that a certain number of people complain of this symptom on admission before any treatment has been started, but still the large number of cases that have complained of this symptom (10 per cent. of the whole) of late makes me think that in many it is due to the atoxyl. I may say that this opinion is not held by all our medical Has come on officers, some of whom look on it entirely as a symptom of sleeping sickness.
Colic and diarrhoea noted in four per cent. of treated cases. generally within twelve, or at most twenty-four, hours of an injection of atoxyl. In four cases it has been of a severe type
Alteration of the vision has been noticed in forty-seven cases. In thirty-three
it has taken the form of dimness of vision. Of these 33 cases-
In 12 the visual dimness has improved.
5 remain in the same condition, getting neither worse nor better.
2 have died with the symptom as above.
14 have got worse.
Four of these cases had marked dimness of vision on admission before any atoxyl had been given them, but still I think that in most of the cases, the atoxyl has been the cause.
It is a suspicious fact that except in these four cases the condition was not noticed in Busiro Camp until September, 1907. The great majority of the people who have suffered in this way have been treated by a system of atoxyl injections entailing a slightly increased dose at each set of injections though in no case has a dose larger than 0.7 gramme been given at one time. Most of the cases in whom it has been noticed were well marked cases of sleeping sickness on admission to camp.
It is curious that only one case has been reported from the Usoga Camp, and yet Dr. Baker, the Medical Officer in charge, has been treating a certain number of cases there with gramme doses of atoxyl.
Fourteen patients have become totally blind (1.2 per cent. of the whole). The details of these cases give in a special table as the symptom is such an important and distressing one.
It will be noticed from the table that eleven of these cases have been treated with increasing doses of atoxyl. That in no case has the dose exceeded 0.7 gramme at a time, that the average period of treatment for each case so afflicted works out at 3 months, and the average total amount of atoxyl taken by each at eight grammes during that period. Three of these people were never given a larger dose than 0.4 gramme. That half the cases belonged to class B and half to class C on admission. Blindness is described as a symptom of aniline poisoning. A certain amount of the atoxyl supplied to us, as I mentioned in my previous report, was of a light yellow colour, in powder, and made up into a yellow solution immediately it was prepared. This yellowness was, I think, due to free aniline. The cases of dimness of vision and blindness which have occurred have all been noticed with one exception since August 1st, and it was at just this time that this yellow atoxyl think this symptom may be due to was being used by our medical officers. aniline poisoning.
Ophthalmoscopic examination of these cases has generally proved negative. Paresis of lower limbs with increased knee jerk is generally looked upon by our medical officers as a symptom of sleeping sickness. Dr. Collyns, however, is of opinion that it may have been due to the atoxyl in twelve cases.
Sudden death.-Seven patients have died suddenly for no very apparent reason within forty-eight hours of atoxyl injection. Post-mortem examinations are not allowed at our camps because of the fear that they would thereby be rendered unpopular. I do not for a moment say that these deaths have been caused by the atoxyl, but the fact is serious, and ought to be noticed.
Two other symptoms have been commonly noticed after atoxyl injections- præcordial distress, and a rise of temperature. Both these symptoms soon dis-
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appear. Aniline is said to cause the formation of methæmoglobin in the blood. Perhaps the præcordial distress may be accounted for in this way.
All our medical officers are of the opinion that, provided that the quality of the atoxyl is above suspicion, the good results in the way of marked temporary improve- ment in the general health, and that the fact that patients are rendered innocuous. and that perhaps cures may be obtained by its administration out-weigh any bad results that may possibly occur through its use, and that until a better substance can be found, we are justified in going on with the treatment.
A. C. H. GRAY,
January 18th, 1908.
Medical Officer in Charge, Sleeping Sickness Extended Investigation.
TABLE showing the number of sleeping sickness patients who presented certain symptoms possibly due to the atoxyl administered to them, showing the amount of atoxyl taken in each case before such symptoms were noticed.
Character of Symptoms Observed.
Amount of Atoxyl Taken-in Grammes.
Totala.
Under 2.
2-1.
4-6.
6-8.
8-10.
Over 10
10
35
31
19
2
...
16
16
6
Marked giddiness Colic and diarrlue 1,
often with vomiting. - Alteration of vision Total blindness Paresis of lower ex- tremities with in- creased knee jerks. Sudden death with no apparent cause. Vomiting only
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735
100
42
33
14
12
7
1
TABLE showing number of patients, type of case on admission, sex, system of treat- ment, maximum dose of atoxyl, and total length of atoxyl treatment before symptom was noticed in patients who have become totally blind.
Class of Case on Admision.
Month of Onset.
Length of Treatment.
Amount of
Atoxyl.
Bystem Employed.
Largest
Dose Given.
Months.
Grammes.
Grammes.
B. (m)
C. (m)
September August
3
10
4.5
0.7 0-7
November
10.5
0-7
B. (m)
B. (m)
November
5
0-7
C. (m)
October ...
10-5
04
B. (m)
October
13.5
(a) and (d)
0-7
B. (m)
September
8
0-7
B. (f)
October November
8
0.7
7.5
0-7
C. (f)
C. (f)
November
8
0.4
June
4
0'4
13. (f)
November
10
0-7
B. (f)
C. (f)
November
5.25
0.6
5.25
0.6
C. (f)
November
32655
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