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C.O.885

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5. No recruiting of labour should be allowed within the sleeping sickness or guard areas.

6. No trading licences should be granted within the sleeping sickness or guard areas. Trade, especially that of the European, means opening trade routes which have been shown to be one of the principal means of spreading the disease.

VIII. Remarks.

Every case of sleeping sickness as soon as it is found will be taken into a hos- pital camp at the sleeping sickness station. Every patient will be under the immediate care of a medical officer, and suspected cases will also be detained in the camp to be under daily observation. The treatment will consist of injections of atoxyl and mercury. The encouraging results from this treatment give us one of the most valuable means of arresting the steady onward march of this disease, both as a curative and as a prophylactic measure, and no time should be lost in making full use of what may eventually prove to be the best means yet found of stamping out the disease. The disease in North-Eastern Rhodesia may certainly, by comparison with the mortality in other parts, be described as being in its infancy, and this advantage should certainly be made full use of in pushing this treatment to its fullest extent at once.

The prevention of the spread of sleeping sickness requires prompt, bold, and decisive measures. It is a disease that always seems, notwithstanding every pre- caution, to keep ahead of one.

This is accounted for by the difficulty of its detection in the early stages, and by The general rule, therefore, is the extraordinary good health of the early cases. for early cases to move about the country, sometimes covering great distances (ride Case 5, Appendix) before anyone has a notion that he carries the infection with him, and no one less cognizant of the fact than the patient himself. In the absence of expert opinion to the contrary the occurrence of a few deaths arouses the first suspicion in the minds of Europeans that it might be sleeping sickness. The disease has then been with them for a period of two years or longer, and the tendency therefore is to start measures when it is too late and when the diseasc is, so to speak, two years ahead. One certain death has already occurred in North- Eastern Rhodesia and there are doubtless others that have not been recorded. If the disease is to be successfully combated at all it must be done at once. Every month's delay may mean the addition of a vast number of infections to the daily increasing toll. Measures must be thorough and rigidly carried out, otherwise an enormous expenditure may result in no material good being done. Lastly, there should be close and cordial co-operation between the various Administrations concerned in this question, such as, I am happy to say, prevails between us and the Congo Free State, The Tanganyika Concessions, Limited, and L'Union Minière. I wish to record my grateful acknowledgments to Major Wangermee, le Repré- sentant du Comité Spécial du Katanga, who unhesitatingly placed the steamer at my disposal on the occasion of both my visits to Lake Mweru, and to Messrs. Hughes, Hall, and Wenham, the Native Commissioners in whose districts most of the work lay, especially the latter, who for nearly 4 months took a most active part in work requiring patience, endurance, and no small amount of physical discomfort.

J. C. SPILLANE, Principal Medical Officer.

January, 1908.

APPENDIX.

Case 1. (October 1st, 1907.)

Chilanga, female, age about 30, of Kalelaula's village, on the left bank of the Mansa River, about 5 miles from the Luapula. Ill for 2 months, complaining of mutu (fever?) and progressive weakness. When first seen on the morning of October 1st she complained of headache. She was unable to walk or stand and had to be lifted by her friends. There were well-marked tremors of the head and hands which increased when she was spoken to. Cervical glands much enlarged and soft. Pulse rate about 100. She was brought in a machilla into camp and when seen again the same night she had eaten her food and was sleeping soundly.

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The next morning she was better and able to walk. Temperature, 995 Puncture of the cervical glands showed trypanosomes. She was sent back to her village. When seen again on October 11th she showed marked improvement and walked voluntarily 10 miles into the camp. She stated that she was quite well again. Said to have lived in the neighbourhood all her life and never been to the Congo. Also stated that her uncle had died of the same complaint at a village 10 miles up the Mansa River. Glossina palpalis found close to the village.

Case 2. (October 11th, 1907.)

Kalioti, male, age about 14, of Kalelaula's village, on the Mansa River, about 20 miles from the Luapula. Complained of swollen legs when he walked about. Went to the Luba country in the Congo (Lualaba) a year ago and remained there for 4 months working as a capitao's boy. First felt ill at Kambove, and since When seen on October 11th he returning has been ill off and on ever since. appeared to be in normal health and ran with machilla into the camp for about No tremors. No ocdema, bright and intelligent. 8 miles. Temperature, 98. Cervical glands on puncture showed trypanosomes. On visiting his village next day his mother and father were both examined and found not infected. The capitao he worked for was Mulutula, who lives at Nkongani's on the Lunkufi Stream near the Luera, a tributary of the Luapula. No Glossina palpalis found on the Mansa at his village. After examination he returned to his village.

Case 3. (November 4th, 1907.)

Chitao, male, æt. about 24, of Kalembwe's village, 15 miles north of Kalung- wisi Station on the lake shore. He began to be ill 3 months ago with fever and headache, since when he has had two more attacks. Now he says he is quite well and strong and 2 weeks ago he returned from Kasama (about 200 miles distant) whence he carries a load to Chiengi. Two years ago he went to the Baluba country (heavily infected) in the Congo Free State and stayed, on his way back, at Pweto and at Chipungu. Temperature normal, tongue clean, no tremors, is fat and looks in perfect health. Glands "+-," trypanosomes found on puncture.

Case 4. (November 5th, 1907.)

Three

George, male, æt. about 16, of Chiengi Village. Three months ago he was ill with headache. He has had no illness since and complains of nothing now.

table boy" on the months ago he returned from Abercorn after working as steamer "Good News" for 3 months. During this time he visited Udjiji, Mtoa, and Usumbura on Lake Tanganyika and saw cases of sleeping sickness there. Now he is doing nothing, but feels quite well and is able to work. Temperature normal. Tongue clean, no tremors, or ocdema. He looks a little thin, otherwise his appear-

if Glands + -," trypanosomes found on puncture. ance is normal.

Case 5. (November 8th, 1907.)

Sabuni, male, æet. about 26, of Muanga's village, Chief Mwao, Luao River, north shore of Lake Mweru. Was ill 6 months ago with several attacks of headache. Not ill now. Went to Broken Hill this year where he worked for 6 months and returned from there a week ago; he has been to Madona, but does not admit having been in the Congo Free State or to Tanganyika. Temperature normal. No tremors. Tongue clean, well nourished, well developed, and apparently in perfect health. Glands " + -," trypanosomes found on puncture.

Case G. (November 8th, 1907.)

Changwa, male, æt. about 10, of Musoma's village, Chief Chipungu, north shore of Lake Mweru, was ill 3 months ago with headache, &c., complains of nothing now. He has been in the neighbourhood of his village all his life visiting only the sur- trypanosomes rounding villages occasionally. Temperature normal. No symptoms of sleeping sickness, well nourished, apparently well. Cervical glands "+ found on puncture.

Case 7. (November 8th, 1907.)

Kafwimbe, male, æt, about 20, same village as Case 6. First ill a year ago with headache, &c., when he came into the country from Chintenti's village beyond

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