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On puncturing the glands trypanosomes are found. The patient usually sits with her head resting on her chest. On the 6th March, 1907, I noticed that she had a left-sided hemiplegia. This condition continued to get worse for about one week, when she got a change, and now, at the time of writing, it has almost dis- appeared.

She remained in this very weak and drowsy condition until about the 25th March, 1907, when I noticed a slight change for the better, and if I describe her condition now, on the 5th April, 1907, you will see that a very great improvement has taken place, e.g., she can now walk about alone with a good deal of confidence, she enters into the conversation, is cheerful, and her attention is easily attracted; the contractures of hands and feet have disappeared, as well as the muscular tremor which has almost vanished; she sleeps very little now during the day, and she is also putting on flesh.

Ilers is a very interesting case, as at one time I did not think she would recover. Whether this recovery has been due to the native medicine, or is only a phase in the course of the disease, I will not hazard an opinion, but it would be a suitable case for lengthy observation.

Trypanosomes still persist in her blood. I only found one after four exami-

nations.

May 29, 1907. The patient was discharged from the isolation camp on the 10th instant, after having been under native treatment for 19 weeks. At present she is under observation in Loko town.

For the past five weeks her physical condition has been improving very much, at present she is gaining weight, and her lethargic symptoms have almost entirely disappeared. She is now bright and cheerful, and can walk tolerably well. Her hemiplegia, although very much improved, can still be easily noticed. Her voice is staccato in character. Iler glands can only be felt with the greatest difficulty, and consequently I am unable to obtain a specimen from her glands for examination.

Trypanosomes cannot be discovered in the peripheral circulation, and owing to her nervousness, I have been unable to procure a specimen from her spinal canal.

Hers was a most typical case of sleeping sickness when first I saw her, and then I thought her recovery was not to be expected. Whether her present recovery will be temporary or not will be a very interesting point to ascertain.

4. Dumgana, male, seven years of age, native of Aquanaga (a village on the Benue near Ibi). Four months under treatment here, now discharged. The only sign or symptom which he had of sleeping sickness was an enlargement of his cervical and inguinal glands. When I saw him he was well nourished, bright, and intelligent, and looked quite healthy. Why he remained under treatment so long was owing to a reappearance of the glandular swellings. Trypanosomes were never found in his blood."

May 29, 1907. Since he returned to his village I have seen or heard nothing

of him.

5. Ode, male, seven years of age, native of Onakate (near Loko). Under treatment for three and a half months, still in hospital. The only sign or symptom of sleeping sickness which he ever had was enlargement of the supra-clavicular and occipital glands. Reason for detention in hospital same as No. 4. Blood examination negative. He is now physically in good health.

May 29, 1907. As stated in my wire of the 14th ultimo, I discovered trypano- somes, as the result of puncturing glands, for the first time, the patient then having been under treatment for four months. The only sign or symptom of sleeping sick- ness which had been evideht up till that time was the polyadenitis.

On the 7th instant, his mother took him away from the isolation camp without permission, since which time I have heard nothing of him. At the time of discharge his glands were still enlarged.

6. Baney, male, 10 years of age, native of a village near Ibi, on the Benue. Five and a half months in hospital, under treatment.

The cervical, submaxillary and occipital glands were all enlarged. He had no other sign or symptom. When seen, he was an exceedingly healthy and well- nourished boy. He has been discharged. Blood examination negative.

May 29, 1907. I have seen this boy since his discharge, and have examined his blood, but without result. IIe continues in very good health. As the result of treatment, he has enormous keloid growths over the site of his enlarged glands.

7. Jama, female, seven years of age, native of Loko. Second time under treat-

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ment. The cause of her return was the enlargement of her submaxillary glands. Otherwise, she was perfectly healthy. The glands were incised, and she was discharged as cured, in two and a half weeks. Blood examination was negative.

May 29, 1907. Trypanosomes were never found in this patient. She is still in Loko. I have examined her gland juice frequently. Polyadenitis still persists.

8. Bamrie, female, 11 years of age, native of Loko. Admitted to hospital 5th March, 1907. She had been under treatment for two months before she had been discharged as cured; she had remained out for six months, and she was then readmitted. She was not put on treatment until the 19th March, owing to the native doctor having been away, and, on his return, there having been some trouble about his fee. She was a pitiable sight on admission, very emaciated and anæmic; could, with difficulty, stand alone; upper eyelids drooping; marked protrusion of the lower lip; and her cervical inguinal glands could be felt at the site of the old scars-her glands having been incised before. Her condition has not improved up to date; she sleeps nearly all the time; never speaks except when spoken to; takes no notice of her surroundings, and is unable to feed herself. The liver and spleen are normal. Her appetite is good, but the food has to be put into her mouth. She is always much better in the mornings; and, in fact, all the patients are much brighter then. Trypa- nosomes were found on puncturing the glands. This will be a very good test case for the native treatment.

May 29, 1907. Since my last report, this patient has become gradually worse, this continuing up till the 25th ultimo, when she died. She was extremely emaciated and slept almost continuously. She was unable to feed herself, food having to be put into her mouth. Nervous symptoms were absent. For a considerable time before her death she was unable to get up or stand alone in the evenings, yet on several occasions when visiting the camp in the early mornings I found her walking about. This morning improvement I have noticed in the other patients. Trypano- somes were present in her glands up till death, but were very scanty there. They were never found in her peripheral circulation. I could only find them in her spinal fluid one week before death, and they were then more plentiful therein than they were in the glands. This patient had been under local treatment before, when she was discharged as cured. She remained out for six months, and was then re- admitted: as stated in my last report I had no opportunity of doing a post-mortem.

9. Aggie, male, nine years of age, native of Ogene, on the Benue River. Admitted to hospital 9th March, 1907. His cervical, supraclavicular, submaxillary, parotid, axillary, and inguinal glands, on both sides, were enlarged. His spleen and liver were also enlarged. His glands had been noticeable for the past six months, so his mother stated. This was the only sign or symptom which he had of sleeping sickness. Trypanosomes were found in his blood; gland punctured, other- wise the boy looked and felt quite well. His glands were all incised on the 21st March, 1907. Trypanosomes are still found.

May 29, 1907. This boy never showed any sign or symptom of sleeping sickness other than the polyadenitis and the presence of trypanosomes in his glands. He continued in good health until the 10th instant, when he left for his home. Trypano- somes and slight enlargement of the glands were present up till the time of his leav- ing the Isolation Camp.

10. Ibraim, son of the King of Nassarawa, 30 years of age, states that he has never been further than Keffi. Admitted to hospital 20th March, 1907. He states that about six months ago he got a very severe headache, which lasted for one month, and was followed by diarrhoea and vertigo, the latter symptom continuing for another month or thereabout. At that time he felt very weak, and was unable to do his work, and he noticed then also that he was sleeping more than usually. He states that his drowsiness kept increasing up to his admission, when he was sleeping nearly all the time. On admission he was thin and anæmic; and his cervical, occipital, axillary, and inguinal glands, and the glands at the back of his elbows, were all enlarged. These glands were all incised on the 21st March, 1907. I did not see him until after his glands had been incised, the native doctor never having told me. I saw him on the evening of the 21st March, 1907, when he said that he felt better than he had done for a very long time, and that he felt no inclination to sleep. lle looked bright, and conversed freely with me. He was very weak. This may

have been from the loss of blood after the operation, as no attempt is made to stop bleeding. Since admission I have never seen him sleep during the day. What he may have looked like before the cutting operation I cannot say for certain, as verhal

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information from these people is very unreliable. However, now I would not call him a typical case of sleeping sickness. Trypanosomes were found after the fourth attempt, and they still persist.

May 29, 1907. In my last report I mentioned the great feeling of well-being which this patient said he experienced after being operated on by the native doctor. This improvement continued for about two weeks during which he was quite bright, walked about, and conversed with the other patients, and did not sleep very much. From about the 8th instant I noticed him becoming duller with upper eyelids droop- ing, and sleeping more than before. He became much weaker, and his glands became much more enlarged and soft, although there was no pus in them. For one week before death he slept almost continuously, and, of course, was unable to feed himself. His legs, feet, and face became cedematous, and diarrhoea was very trouble- some. Nervous symptoms were not evident. All the symptoms, reported above as being present, became exaggerated until the 22nd instant, when he died. Trypano- somes were found in his glands and spinal fluid up till death, but never in his peri- pheral blood.

11. Ramatu, female, native of Loko, 26 years of age. States she has never been away from Loko; admitted to camp 13th April, 1907. For the past six months she has been feeling weak, and sleeps more than usual. At present she is fairly well nourished, but has a very dull expression, and marked drooping of the upper eyelids. Her glands are but slightly enlarged, only about the size of No. 5 shot. Being unable to get a specimen from her glands or spinal canal, I could not find any trypanosomes at first, but was fortunate, after the eighth specimen had been taken, to discover one trypanosome in her peripheral blood. Her condition since admission remains unchanged. When she is asleep one can notice marked twitching of her fingers, and a tremulous movement of the head, not present when she is awake. She is now under observation in Loko.

12: Isifu, male, born near Zaria, 14 years of age. This patient states that for the past three years he has been in the habit of coming each year to Lafia, Nassarawa, with his father, who is a hunter. Sleeping sickness exists at Lafia. He, however, confidently states that his glands were enlarged before he came to Lafia the first time, and that they were treated by a native doctor at Gani, near Zaria. He further states that the native doctor at Gani punctured the glands with a red-hot iron, and gave him some medicine to drink, which caused the enlargement to dis- appear. These, however, became enlarged again about six months ago, since when he has been becoming much weaker and has been sleeping a good deal. This latter I have verified. On admission he had well-marked polyadenitis, and was thin and badly nourished. Of a very excitable nature; he is of bright, intellect, readily answering questions put to him. Trypanosomes were found on the fourth occasion on which puncture of glands was practised. He has now been under treatment since the 8th instant: there has been no change in his condition up to date-29th May, 1907, and trypanosomes are still present. He asserts that he saw one man with sleeping sickness at Zaria, who eventually died there.

I had hoped to be able to obtain more cases for examination, but I am afraid the reports at first were a little exaggerated re number of cases occurring. I have examined a great number of cases, but have been unable to find trypanosomes in any, except those mentioned.

It would almost appear that the trypanosome very rarely appeared in the peripheral circulation, and even then very scantily.

The following is the native doctor's method of treating cases. To preface my statement, e.g., the native doctor considers glandular enlargement to be pathogno- monic of sleeping sickness. When case No. 3, Amala, got hemiplegia and contrac- tion of the hands, he said she was possessed of an evil spirit, and that it would be necessary to obtain medicine from the Juju man.

Treatment. With a native lancet, and without any antiseptic precautions, he makes four or five parallel incisions, about one inch long, over the gland, and, at right angles to these, four or five other incisions about the same length, so [sic in original] All the glands are incised at the same sitting. These are allowed to bleed freely for about three-quarters of an hour, then the leaves of a plant, called by the Housas "Rupwa," are wrapped in a large leaf and covered with hot ashes, and allowed to remain about one hour. Incinerated leaves are now powdered on a piece of hot earthenware pot, then made into a paste with a little water, and thickly smeared over the incisions. The patient is then confined to a hut for seven days, when the

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wounds are washed, and nothing further applied; the result, in many cases, being a large keloid growth over the incised site."

The following is made-Equal portions of the leaves of (1) Jujonshi, (2) Geba, (3) Banchibokan, (4) Ekanshi are put in a pot, and covered with water and boiled for one hour. The resulting decoction is used for cooking all their food in, and for drinking, no other fluid being allowed.

During the treatment no meat of any kind is allowed. If the glands again become enlarged, the process is repeated.

I have seen a good number of people here who have gone through the treatment, but the only sign or symptom which they had was the enlarged glands. So the fallacy of drawing conclusions from these cases is self-evident.

If the four trypanosome-infected cases now in the hospital could be kept under observation for, say, one year, one would be able to give an opinion re efficacy of treatment. All I feel justified in saying at present, without being optimistic, is that I am inclined to strongly advocate the continuation of the investigation.

To me, incising the glands excision would probably be better-seems rational in the early stages, as it may be possible that the disease, trypanosomiasis, may be

then localized.

The only fly, Tsetse, which I have seen here, I caught in my house. I believe it was G. palpalis, but, unfortunately, it escaped when I was putting it into the killing bottle.

May 29, 1907. I have been three months at Loko, in that time I have seen 12 reputed cases of sleeping sickness under the care of the native doctor. Nine of these were infected with trypanosomes; they all had polyadenitis; and three of the infected cases died with symptoms of sleeping sickness, after having been under local treat- ment for 21, 19, and eight weeks respectively.

One case, No. 3, was under treatment for 19 weeks. She was a very typical case of sleeping sickness, and in her there has been a very marked improvement. She is still under observation at Loko.

The condition of Nos. 5 and 9 remained unchanged, they never having shown any sign or symptom of sleeping sickness, except glandular enlargement.

Nos. 11 and 12 are still under treatment, both being fairly typical cases of sleep- ing sickness, but, up to date, there is no change in their condition.

Thus, of the nine cases in which trypanosomes were found, only in one has there been any marked permanent improvement up to date. What this improvement may have been due to is difficult at present to say, but remembering that there has been teinporary improvement in some of the fatal cases, I am not very hopeful about

this one.

I am of opinion that the trypanosomiasis is of a very chronic type on the Benue; the history of some of the cases reported leads me to believe so, and this question arises is trypanosomiasis capable of spontaneous cure, or can a mild infection be borne without causing any appreciable harm to the individual?

Certainly, in an endemic area, such as the valley of the Benue River, where the disease has been known so long, such a condition may be possible. Game lives unharmed by the presence of trypanosomes in the blood, and it is said that if it were possible to keep an animal suffering from trypanosomiasis alive in a tsetse area while she was suckling her young, and if, at the same time, her young were bitten and infected with trypanosomes, her progeny would become immune to the infection. For the diagnosis of sleeping sickness, I found examination of the peripheral blood of very little value, gland juice or cerebro-spinal fluid being more trust- worthy.

Polyadenitis appears to be a very constant sign, and is the only one which the native doctor here relies on.

Temperatures are very irregular, mostly sub-normal, patients, as a rule, com- plaining of the cold.

now.

Tsetse flies, of the varities G. Tachinoides and G. palpalis, are plentiful here

I can obtain no history of an epidemic outbreak in these parts, but, now that travelling has been made easier and quicker, such an outbreak may possibly occur at any time in a tsetse fly-infested area--Glossina palpalis. So that in my opinion a case of polyadenitis, coming from such a fly-infested area, should be regarded with the greatest suspicion, and isolated. Touching the efficacy of the native