PUBLIC RECORD URTIGLI
Reference
!।:「 །‛།: mmimmin C.O.885
19 PUBLIC RECORD OFFICE, LONDON
ALLY WITHOUT PERMISSION OF THE BE REPRODUCED PHOTOGRAPPIN“
1907-
Month.
August September
October
November
Total to date
NI
୫
Admissions.
نال
47
175
90
328
Deaths.
3
18
1 »
This camp up to the present seems very popular with the Basoga. Only two patients have left since its institution. As at Buwunka, very many of the patients are in an advanced stage of the disease and will no doubt soon die.
Kyetume Camp, Chagwe.
It was not until August 21st that a medical officer was available for this Camp, but Dr. van Someren, on his arrival, found that camp construction was in full swing and that patients were already there waiting for treatment. Dr. Bayon joined Dr. van Someren on his arrival in the country on October 14th.
1907-
August
Month.
September
October
November
Total to date
Admissions.
Deaths.
82
81
110
6 6
50
326
At present this camp seems very popular. A large number have come from the islands of Buvuma, where sleeping sickness is extremely prevalent. There are at the present time no less than 62 children under the age of 15 in the camp. Dr. van Someren says that, in his experience, the children make the most satisfactory progress, and that if only more of them could be got to come for treatment, our efforts to treat this discase would be more successful.
TREATMENT WITH ATOXYL, &c.
Every patient who comes to one of our camps is treated with atoxyl. An injection is given on the day of arrival and the treatment continued for from four to six months. The patients nearly always know about the treatment before they come and quite expect to be given the injections. It is only quite occasionally that any objection is offered to the treatment. In this respect the use of a fine and sharp needle to the injection syringe is important as it minimises the pain.
A freshly prepared 20 per cent. solution of atoxyl in distilled water is used. The solution must be freshly prepared, it soon turns a brown colour if kept for long and is then useless. It is also important to keep the solution in a coloured bottle.
in order to completely dissolve the drug A three cubic centimetre all glass syringe The syringe is sterilised by heat and then carbolic acid is used because this acid
The solution is warmed before use and to render the injection less painful. is the one generally used at our camps. put into weak boracic solution. No decomposes atoxyl.
The following is the method of administration:-
A spot between the patient's shoulder blades is cleaned, the needle of the syringe, which is kept lying in weak boracic solution, is then inserted well under the skin and subcutaneous tissue from above downwards. The syringe con- taining the measured quantity of atoxyl is then attached and the solution slowly injected. This guards against the possible breakage of the syringe from a sudden movement on the part of the patient.
METHODS OF INJECTION.
A. The original method employed. 4 grammes given on twentieth and twenty-first days and repeated in the same way. This method soon gave way to the next one (B).
B. The same method, but the doses given on the tenth and eleventh days.
9
C. Same as "B," only that the doses are increased gradually by 5 c.c. at a time until a maximum of 4 c.c. is reached.
D. Method recommended by Dr. van Campenhout, starting with a very small dose given and increased every five days up to a maximum of 07 gramme and then decreasing.
E. Method lately recommended by the German Commission, viz., one gramme (5 c.c. given on two successive days) and repeated on the fifteenth and sixteenth days.
F. Atoxyl followed by the administration of mercury by the mouth.
G. The administration of sodium amino phenyl arsinate (Burroughs and Wellcome).
In addition to treatment with atoxyl, strychnine is given to any advanced cases. The giving of mercury after atoxyl has been instituted on the advice of the Liverpool School of Tropical Medicine.
When cases of sleeping sickness arrive at our camps they are thoroughly examined by the Medical Ollicer-in-Charge, and, according to their symptoms, are divided into four classes as follows:-
Class A.-Those who present the following symptoms:-Fever, gland enlarge- ment with trypanosomes present in the glands. Very often such cases complain of headache and pain in the stomach. There is no tremor. The patients on admission generally say they are well, do not think that they have sleeping sickness, or they may give a history of a few weeks' illness.
Class B-Those presenting the following symptoms:-History of fever and some drowsiness. Think that they have got sleeping sickness; say, as a rule, that they have been ill several months. Marked gland enlargement and trypanosomes present. Impotence of some months duration as a rule or else amenorrhoea. Skin generally dry. Some slight wasting. Tremor of tongue, but not of lips or fingers. Class C. present the following symptoms:-Well marked cases of sleeping Tremor of tongue, sickness. History of illness for the last year or more as a rule. lips, and fingers. Wasting. Dry rough skin. Generally the feet are swarming with jiggers. Such cases walk with difficulty, and are very obviously ill. They are very often either imbecile or else maniacal. Marked oedema of the lower limbs and around the eyes is often present. The lymphatic glands are enlarged and contain trypanosomes.
Class D-Very advanced cases of sleeping sickness. Such cases are semi- comatose, and have to be carried to the camp. Are generally a mass of chiggers, and in a very filthy state. Food is only swallowed with difficulty. The mouth and lips are covered with sores. Paralyses are common.
It is too early yet to say very much about the value of atoxyl as a remedy for sleeping sickness. Only a few of our cases have been under observation for as long as 12 months. In the following table the after history of those cases admitted to our Busiro Camp up to August 1st is tabulated.
Only undoubted cases of sleeping sickness are included in this table, and all cases who have died of some intercurrent disease, or have run away, are excluded. The admissions for each month are kept separate for the reason that a case admitted in December, 1906, or January, 1907, has been under observation so many months longer than subsequent admissions.
All cases in this table have undergone a course of atoxyl treatment for at least four months. Methods A., B., C., and D. have been those generally employed. (Sce above for methods of giving atoxyl).
Cases admitted in December, 1906.
Class of Case on Admission.
Present State, November 30th, 1907.
Totals.
Class A.
33 Casca,
Class B. 51 Cases.
Class C.
Class D.
30 Cason.
9 Chacs.
Showing improvement after a course of
atoxyl. Not now taking the drug. Continue to take atoxyl. No marked im-
provement.
10
21
4
44
6
3
9
Relapsed after temporary improvement.
Atoxyl resumed.
13
10
3
26
11
20
9
44
123
Died after a course of aloxyl
Total admissions treated ...
3265 6
10
Cases admitted in January, 1907
Class of Case on Admission.
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