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for six months. Also markedly anæmic. Has little shotty glands in neck. They say it has been sickly since birth. Trypanosomes found in blood.
No 7. Siamanda, of Lupondo. Male, 23.-Taken ill at end of rains. Glands : a hazel and some little ones right, a bean and some little ones left. Trypanosomes in gland juice.
Blood. One trypanosome in slide. No tremor. Slight oedema of feet. Com- plains of pains in feet. Walked over from his village (distant two miles) to be examined, but is not in the habit of walking so far. Marked muscular wasting.
No. 8. Ngwathla, of Chamayua. Male, about 30 (from question), but looks at least 40.-Discharged from Wanderer Mine, April, 1910, and was at his village two months. Then went with a white man to Bandala, on the Seng'wa, and back vid Manzatuba and Sinasitonka. On return was taken sick and has been sick ever since without intermission.
Sickness began in his legs, and has been in his legs ever since.
Thin and wasted. No tremor. Slight oedema of feet. Glands: short chain of beans each side. Trypanosomes in fluid.
No. 9. Sianzuwa, of Sibaba. Male, 30.-At the beginning of the dry season he went to Mbopo, thence with Government mules round by the Zambesi to Gwam- pongo, thence via Nkoka, Sinasitonka and Buwampu back to his home. After this trip he had no illness. In June he was one of the carriers who took Mr. Taylor to Malindi. Has been at his village since.
On September 26th he was examined by me and a suspicious gland was noted, but owing to some mistake he was nowhere to be found when called up for gland puncture. At that time he was beginning to feel ill, but was going about as usual. He says that he got worse gradually.
On November 12th, on revisting this village, I found the same man wasted and obviously ill. Walks slowly, with a stoop. Complains of feeling ill all over; head, body, and down thighs. Speaks perfectly and is fully intelligent. No tremor. No oedema. T. normal Glands: a chain each side, beans, and little gland. Try- panosomes in gland fluid.
Fly is absent or certainly very scarce at Sibaba; three or four miles away it occurs in fair numbers. Impossible to say where and when infection took place.
No. 10. Mwanapegwa, of Siabutenga. Male, 30.--No fly at village. During the dry season went to Nyika. At the crossing of the Busi River found tsetse very numerous. On the fourth day after getting back was taken sick. Has been ill four months. Was carried from village to my camp, being unable to walk. Complains of his legs and feet.
Not thin to look at, but when one feels a limb it is absolutely flabby.
Glands a chain on each side, size of peas. Trypanosomes in gland juice. Temperature normal. Some oedema of feet. No tremor. Intelligent and has no difficulty in speaking. Says that sickness came on suddenly and was very bad at first, with severe headache.
No. 11. Sabusa, of Bandala. Male, 30.-Fly numerous at village. Was at home hoeing his garden all the rainy season. Illness began in March last, with severe headache. Now complains of legs and of difficulty in seeing. Came to my camp walking slowly with a stick. Legs obviously wasted. Edema of face, par- ticularly about the eyes. Slight cedema of feet. Has marked varicose veins on abdomen.
Seemed quite intelligent, but after sitting on the ground a few minutes he began to dose. His friends say that he sleeps a good deal in the daytime.
Glands: a string of two or three beans each side. Blood negative. No tremor. No ascites or enlargement of liver or spleen. Nothing visibly wrong with eyes except oedema.
The village is a small one in the bush. The people have small gardens, and no doubt spend much time in the bush trapping and looking for fruit and roots.
Diagnosis.
Nine out of eleven cases by gland palpation and puncture.
The two cases in which diagnosis was established by blood examination were :-
(1) an infant with little shotty glands;
(2) my carrier, in whom trypanosomes were found on first day of sickness. In the nine cases diagnosed by gland puncture, blood noted positive twice, negative three times, and no note four times.
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There were 170 negative blood examinations of people in fly belt. Half of these were healthy people at Buwampu and Sinasitonka's, i.e., in the thick of the fly. The object was to find out if apparently healthy people may have trypanosomes in their blood. The other half either had some fever or looked thin or poorly.
It seems that in this form of sickness gland puncture is of more general use in diagnosis than examination of blood.
Clinical Features.
Comparison with trypanosomiasis seen in Katanga.
The symptoms are of the same nature in both cases, viz., recurrent attacks of fever, headache, pain in limbs, muscular wasting, œdema, tremor and symptoms referable to central nervous system.
The most obvious point of distinction is the much greater severity of this sickness. In Katanga the average duration of untreated cases is not known, but it is probably two to four years. Among our 11 cases one dates back two and a-half years, and the rest all trace their beginning to less than six months ago. It is exceedingly unlikely that there was only one case in 1910 and one in 1911. The reasonable inference is that the disease rarely lasts more than a year.
In Katanga, again, subjects of the disease are, as a rule, found going about their ordinary work. A subject obviously ill and wasted is getting near the final stage of the disease, and if you enquire among his friends you generally find that he sleeps in the day time. In our series of cases 9 of the 11 were obviously ill when first seen. One who had been infected for some time was not obviously ill, and one when first seen had nothing but a suspicious gland; a month later, however, he was very sick and much wasted.
Probably on account of the greater severity of the sickness it is much easier here to find trypanosomes in enlarged glands. Of our 11 cases, 5 had the distinc- tive chain of glands, and 5 others had only one or two enlarged glands which would of themselves give rise to no more than a suspicion. In every case, however, try- panosomes were easily found at the first puncture.
In Katanga it is not at all uncommon to find cases with the typical chain of glands in which one has to try again and again before finding trypanosomes (this is particularly the case with well-fed boys in European employment). Pearson has reported a case which came under him after three other doctors (of whom I was one) had failed to find trypanosomes, and in which he himself found them at the fourth puncture.
A little point worth noticing is that in Katanga one looks to find trypanosomes most easily in a milky or yellow gland juice. If the juice is watery one expects to find them only after a long search. In this sickness I have seen, three or four times, numerous trypanosomes in juice which looked like pure water.
The frequency of pain in the legs and feet and of cedema of the feet seems to be the characteristic feature of this sickness (after its severity). I think it is very likely that I missed oedema of the feet in my first cases through not looking for it.
Trypanosomiasis of Domestic Animals. Trypanosomes were found in 2 goats, 6 sheep, and 12 dogs (51 goats, 24 sheep, and about 20 dogs were examined).
The method followed was to look at the herd and select a few poor-looking animals for blood examination. No attempt was made to examine all the animals
or to form an idea of the percentage infected. Even if all the animals were examined carefully, the result would be fallacious, for the reason that sheep and goats seem frequently to pass from village to village either through purchase, removal of the owner. e.g., when he marries, as gifts to a bride's mother; and also when food or water fails the animals are driven off to another village.
Goats.--According to the natives, goats did well in the fly before the rinder- pest. When the fly increased again they began to die, but the fly is not so fatal to them as to sheep. At some villages they seem to have noticed this sickness as long ago as 1904, but in most cases they give two or four years ago as the beginning.
The animal gradually grows thin and weak but does not lose its appetite. Both the goats in which I found trypanosomes died a few days later, although trypanosomes were in one case very scarce (three films examined and two trypano- somes found).
As I examined altogether 51 goats, selected on account of their poverty, and
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