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sent to the dispenser. I met him later, after hunting for him for days. This is the only disease I know where infective diseased persons are not allowed freely to mix with others.
2.
In 1912 I saw two cases at Kamayototo, and a third in the same village was absent at the time of my visit. Clinical symptoms were very clear, but I did not find trypanosomes in the blood, two films from each case. Dr. Simpson, the entomo- logist, also took films to have them examined in England, but I have not heard the result. Lately I saw one clear case, clinically, at Boalakarafia, and several sus- picious cases. I delayed answering until I should have examined blood films from each. I have done so, two films from each case, but have not found trypanosomes. I may state that I have found trypanosomes in the blood of cattle in this district, afterwards confirmed by Professor Nuttall. He did not mention the species.
seen
A copy of my report on the cases in 1912 was forwarded to the Principal Medi- cal Officer on 10/5/12, letter No. 56. I enclose herewith a report on the case last patrol.
In the annual report for 1909, Dr. Allan mentions the death of an in-patient of Kaballa Hospital from trypanosomiasis. Gland and lumbar puncture is practically impossible to obtain, owing to the prejudices of the natives. It is very difficult even to obtain blood-films, and in some cases impossible.
2A. In this Colony I have seen no definite cases of sleeping sickness other than those mentioned above, but in Ronietta District I saw some suspicious cases which I had not an opportunity of diagnosing or of following up.
3. Glossina palpalis is extremely common in this district, as you will see from the copies I have forwarded you of indentifications by the Entomological Research Bureau. I have copied these lists into the station letter book, and am now prepar- ing a map showing the places and streams where found. Dr. Murphy reported that practically every stream in the district was infected, and I have found this to be the case. Other Medical Officers have also collected them in the district, but no records whatever of places or dates have been kept in the station. Kaballa, itself, stands. almost alone in that during two years of residence I have never found Glossina palpalis in the valley. There is another small area among the Kele Limbas, three days' march from Kaballa, among heavy bush, where I was unable to find tsets? flies on two different patrols. Previous to coming to this district I had not taken up the collection of glossine; I cannot therefore say I know of any other tsetse free area in the Protectorate.
I have, &c..
Kaballa,
21st October, 1913.
A CASE OF SLEEPING SICKNESS.
JOHN Y. WOOD.
KEKURA, a male of about twenty-five years, has been ill for about one year. Heard of him at Ninkintumnania, tracked him to Serakoria, Boalakarafia, and Yara- konkofeh, and sent for him. Says he went to see me at Kaballa, but was driven away by the people, this being confirmed later. I have heard of several similar cases of suspected sleeping sickness being driven away by their neighbours. Patient is dull but speaks all right. Does not remember fever or headaches. Eats well, but is always sleeping. Whole body and limbs swell at times, especially feet, every few days, but not to-day. Has grown fatter. Brain and memory are being affected more and more, goes to places and forgets what he has gone for. Took a month to go to Kaballa as he was alone, and at the different towns on the way he constantly forgot where he was going and for what purpose. Eyes are heavy, but when aroused follow movements of finger normally. Face twitches when speaking. Very restless when aroused and easily irritated. No tremors of limbs or muscles or tongue, gait unsteady and irregular. Skin very dry and extremely itchy. Tongue flabby and coated. No redema, but eyes puffy. Muscles of legs very tender to touch, but not the arms. Knee jerks exaggerated. Glands of neck, behind and before, and of axillæ, all enlarged, some up to inch, but most smaller. Liver and spleen not enlarged but tender. Heart irregular and rapid, with snapping first mitral, other- wise very soft. Respiration rapid, pulse 87, temperature 9920. Blood, two films shows no trypanosomes, but large number of curious myclocytes.
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2. Case reported to me as sleeping sickness, suspicious but indefinite. Yele Surie, trader from French Guinea, returning at once. Age about thirty- five. Began to sleep about three months ago. Recurrent attacks of fever and head- ache (violent), no pain, tenderness or tremors, tongue coated but no tremor, knee jerks normal, no enlargement of liver or spleen, no cedema, heart irregular and rapid, first aortic roughened, second snapping, skin itches but not dry, eyes normal but eyelids droop and seem puffy. Speaks well. Glands of neck, both behind and before, also of axilla and groin all enlarged. Blood dark and very liquid. trypanosomes found in two films, but the same curious myelocytes in large numbers as in case 1.
No
Two boys also complained of sleeping and fever, with headaches, with enlarge- ment of glands but nothing definite, except that in a film in one a malarial crescent was found.
In February of this year a boy of about ten years was seen who complained of sleeping constantly. He had large inguinal glands, one breaking down and painful, others loose and short-like at the back of the neck and in the axillæ, the lips were covered with scabs and the boy seemed scarcely able to keep awake. Eyes heavy, skin dry and dull. Spleen and liver did not seem to be enlarged, but were tender and abdominal pain was complained of. The boy was dull and yet very nervous with tremor of muscles. He stated his illness began some years ago with frequent attacks of fever and headaches. No blood-films were permitted, but his father promised to send him to Kaballa for observation and treatment. I have not seen him since.
JOHN Y. WOOD. 21st October, 1913.
Trypanosomiasis.
Horo Fatmata, female, about thirty years, at Kamayototo. This woman lived in the same house as the woman I reported as suffering from sleeping-sickness at Kamayototo in 1912, and included in the report I sent in lately of sleeping-sickness in this district.
She complains that she sleeps very much, but only if she sits or lies down, and when once she is asleep she is unable to wake again unless very forcibly aroused. This has lasted for about seven months and is increasing. It began with pain about the umbilicus, which gradually rose up to the heart, where now it is fairly constant, although at times it is much worse. She belches wind and sometimes dare not eat, even if very hungry, owing to the pain of the dyspepsia, diet making no difference. Every night she has fever and sweats, but has no headache. She has not menstruated for six months and is gradually growing weaker, although at the same time she is getting fat. Her feet sometimes swell up, and most of her joints are painful. No change has been observed in the quantity or colour of the urine and there is no pain in the region of the kidneys. Her skin is very dry and itchy.
The glands of the neck, both behind and before, are swollen to the size of a bean, as also some at the elbow. Her eyes are heavy and puffy, but otherwise there is no edema. There are very distinct tremors of the hands and tongue, and the latter is heavily coated. The liver is normal, but the spleen is enlarged to a finger's breadth below the border of the ribs. There is great tenderness round the umbilicus. Res- piration is hurried, pulse 75, temperature normal (2 p.m.). On auscultation of the heart there is a blowing murmur with the first aortic sound, and the second has the same peculiar snapping sound observed in the other cases.
I took two blood-films, the blood being extremely thin and anæmic (one trypano- some was subsequently found in each of the two blood-films taken).
Of the cases previously reported at Kamayototo I find that the woman died about a year ago after having coughed and spat blood for three months. The man died in French territory some time last year. The third case reported to me at the time, but not seen, is said to have since recovered and gone to live at Karasso.
The case I recently reported at Boalkara faia was found a few days after I saw him, "lying on the ground outside the town, writhing in agony, having comited, and pulseless. There appeared to be much mucus in the trachea." Struggling continued for twenty minutes until death. He had appeared to be as usual that morning. I have already stated the great fear the people were in, and would suggest he poisoned to remove the danger.
JOHN Y. WOOD.
Was
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