PUBLIC RECORD
OFFICE
།།། །།
Reference :-
C.O. 885
22 PUBLIC RECORD OFFICE, LONDON
ALLY WITHOUT PERMISSION OF THE BE REPRODUCED PHOTOGRAPHIC-♪ COPYRIGHT PHOTOGRAPH-NOT TO
10
is held daily near the camp; and, in addition, the "friend" villages for further purchases.
may
visit neighbouring
Every encouragement is given to all in the camp to practice their customary occupations, and an allowance of tobacco may be earned by any willing to do other work, for instance, on the new buildings now in course of erection on the hill.
Convalescents are occasionally allowed to leave the camp during the dry season when the flies are less numerous.
The sleeping sickness camp is situated on the grassy plateau of the Kluto at an elevation of about 1,800 feet above sea level. The area included measures about one-third mile by one-quarter, and is roughly divided by a broad road running from east to west, and continuous with the road from Misahöhe. The Medical Officer's quarters, offices, and laboratory are placed at the eastern end, and are distant from the segregation camp only a little more than 100 yards. The huts for accommodation of patients and attendants are arranged to the west in parallel rows on either side and at right angles to the main road. There is a sufficient spring-water supply a few hundred yards to the south, and shallow pit-latrines are provided to the north.
There were 48 patients resident in the camp in September of this year.
TREATMENT.
The total number of patients treated in the camp since its establishment in 1908 is 593.
Thirteen in all have escaped from the camp; six after commencement of the treatment, seven before. Of those ordered to the camp by the travelling Medical Officer, 24 failed to put in an appearance. Of these the greater number were natives of Kete Kratchi, and are supposed to have made their way over the boundary into British territory.
Complete records are available for 355. Of the balance, 48 still remain under treatment, 13 ran away, and a number died from diseases other than sleeping sickness. The number given, 355, represents those patients who have undergone a complete course of treatment.
The earliest treatment was with atoxyl; the next, which shows a distinct advance, was with arsenophenylglycin, and this has, during the last twelve months, been superseded by salvarsan or some modification thereof given at first intravenously, later intramuscularly.
(1) Atoxy]: A total of 15-20 injections up to 5 gram each, given every tenth
and eleventh day.
Per cent. cured.
52.6
No. of cases.
57
Cured.
30
(2) Arsenophenylglycin: Two injections on successive days, varying from
04 gram to '06 gram pro kg. of body weight.
No. of cases.
233
Cured. 180
Per cent. cured.
77
(3) Salvarsan :
No. of cases.
20
Cured.
19
Per cent. cured.
95
(4) Neosalvarsan :
No. of cases.
*45
Cured.
37
Per cent, cured.
78.7
The most recent treatment practised by Dr. von der Hellen is the following:-
(1) On three successive days, three times a day : 2 gram tryparosan. (2) Next two days, three times a day: 11 gram trypaflavin.
(3) The following day and again two days later: intramuscular injections of neosalvarsan 025 gram pro kg. of body weight. No records for this last form of treatment are as yet available.
During the entire period of detention in the camp, a very careful note of the temperature is taken morning and evening, as it is by this means only that a
A number of cases still under observation are not "officially " declared cured.
*
11
relapse can be discovered with any degree of certainty. A temperature of 37·4° is looked upon as “ critical," any rise above that probably, although not necessarily, implying a relapse, and frequently a return of the trypanosomes to the peripheral circulation. Blood examinations are made on these occasions for the purpose of determining their presence, and of excluding malaria.
From the records it appears that by far the greater number-95 per cent.-of relapses occur within the first four months after commencement of the treatment.
The method of treating sleeping sickness with salvarsan, or its more recent modification, has much to recommend it. The whole procedure does not take more than ten days; there is little danger-provided every care is taken—and the results are apparently most satisfactory. Such excellent results, of course, can be expected only in those who come under treatment at an early stage of the disease. Like any other form of treatment, it is rarely of lasting benefit in advanced cases with marked nervous symptoms.
The actual period of detention in the camp is not mentioned, but is not less than six months, and often as much as, or more than, twelve; the latter always when there has been a relapse. The patients "discharged under observation are required to report for examination not less than once every third month. Each patient so dis- charged is furnished with a form, on which all details referring to his illness are entered, and this form has to be shown whenever he returns for examination.
In the Gold Coast Colony previous to 1910 only a few isolated cases of sleeping sickness were reported. In that year a Special Service Officer, Dr. Allan Kinghorn, was sent to the Western Province of Ashanti, and, after an extensive tour lasting from March until October, he submitted his report.
Dr. Kinghorn examined in all 16,654 natives out of a total population estimated at from 60-80,000. He demonstrated the presence of the parasite in 97, a percentage for the number examined of 58. He found that the disease was most common in the forest land, and corresponded in distribution with that of the tsetse fly (Glossina palpalis). The disease was apparently of considerable antiquity in the country, and appeared to exist in a chronic endemic form."
Dr. Kinghorn's work was continued in 1911, 1912, and 1913, by Dr. W. M. Wade. This officer has recently submitted a report on his work for the first six months of the current year. In his opinion the disease affected mainly those who are not indigenous in the country, but have come to it only for purposes of trade or to find work, and have resided in it only for a comparatively short period. It is particularly uncommon amongst the pure indigenous Ashanti, who "appear to have acquired a degree of immunity."
Dr. Wade examined a total of 39,742, and found 110 infected, a percentage of only 28.
On the eastern side of Ashanti, Medical Officers have been stationed in Kratchi from the beginning of 1911 until the end of 1912. Here a small camp was estab- lished; a number of cases collected and isolated; and treatment given with a fair measure of success. The officers were Drs. Keigwin, Slack, and Dowdall.
At Anum similar work was carried out by Drs. Horn, Claridge, and Oakley. Search for infected cases in this district has not been successful, although the fly (Glossina palpalis) is common, and the district is adjacent to the German province of Misahöhe.
Further reports of sleeping sickness have been received from Addah (Dr. Palmer, 1 case); Komfrodua (Drs. Moffatt and Connal, 7 cases); and Salaga (Dr. Oakley, 3 cases).
Towards the end of 1910 or beginning of 1911 a proposal for an agreement for the control of sleeping sickness in Togo and the Gold Coast was made, and received the sanction of the home authorities on the 17th August, 1911. This agreement has now been operative for two years, but its administration is considered to he attended with but little success, and to be lacking in harmonious co-operation. Complaints have been and are made by each side against the other. The German medical authorities-and not less, the Administrative-assert, especially with regard to paragraphs 1 and 3 of the Agreement, that there is too great a divergence in the methods practised by the two Powers-a divergence so great as to impair very
33305
B 2
11
No comments yet.
Private notes are available after approval.