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PUBLIC RECORD OFFICE
Reference :-
IC.O. 885
23 PUBLIC RECORD OFFICE, LONDON
ALLY WITHOUT PERMISSION OF THE BE REPRODUCED PHOTOGRAPHIC- COPYRIGHT PHOTOGRAPH-NOT TO
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FROM THE PRINCIPAL MEDICAL OFFICER to THE MEDICAL OFFICEr at
(Circular No. 14.)
I SHALL be grateful if, at your earliest convenience, you will furnish me with such information as may be in your possession with regard to the following:-
1. Is sleeping sickness known to exist in your district?
How many cases have you seen yourself and in what proportion of these
cases have you confirmed the diagnosis by
An examination of the blood,
(b) Gland puncture,
(c) Lumbar puncture?
2. How many cases of sleeping sickness have you seen during your service in this Colony and where?
3.
Is Glossina palpalis commonly found in your station and district?
4. Do you know of any tsetse-free area in the Colony or Protectorate?
Colonial Medical Department,
Freetown, Sierra Leone,
9th September, 1913.
THOS. E. RICE,
Principal Medical Officer.
H. E. ARBUCKLE, MEDICAL OFFICER, to THE HONOURABLE THE PRINCIPAL MEDICAL OFFICER.
SIR,
I HAVE the honour to report on three (now four: T.E.R.) cases of trypanoso- miasis at present in the Colonial Hospital, Freetown.
Case 1. Blackie, a Mendi, æt. circ. 19 years, came as an out-patient to the dispensary, Freetown, on the 7th November, complaining of some abdominal disten- sion and weakness. On admission into hospital, he had a slightly distended abdo- men, with an enlarged spleen, two fingers' breadth below the costal margin, some flat, discrete, enlarged, post cervical lymph glands; his tongue was tremulous on protrusion, and there was some tremor of the fingers on extension. The knee jerks are present, and there was no deep hyperesthesia. He complains of pains all over the body. Before coming into the hospital he says he had insomnia.
Gland puncture revealed trypanosomes. He is a Mendi from the railway dis- trict of the Protectorate, but went to Fernando Po three years ago and worked there, until a month ago, when he returned to Freetown, where he has been living at Wilberforce Street. He states that when he landed in Freetown he felt ill, and had done so for a month previously. While in hospital he has been given atoxyl in 5 grains doses twice a week, and it is stated he does not sleep during the day so much now as when he was admitted to hospital.
Case II. James, a Mendi, residing in Freetown, came to the dispensary here as an out-patient on 14th November, complaining of pain in his right leg and arm, which began about two months previously. He is about thirty-two years old, has a stupid drowsy look, and is very slow in speaking or understanding what is said to him. He says he has forgotten where he was born, and will not tell where he comes from, but states that he has been living in Freetown for a year; his last residence in Freetown was Kroo-town road, but he cannot tell if this was his only residence. His speech is very indistinct and slurred. He has enlarged post cervical glands; the femoral and inguinal glands are large, flat and discrete, and painless; the spleen is not palpable; the tongue is very slightly tremulous, but not so the fingers on exten- sion. There is no deep hyperesthesia; puncture of the cervical glands revealed the presence of trypanosomes.
Case III. Bai, a Timne, cet. circ. 34 years, came as an out-patient to the Colonial Hospital on 17th November, complaining of fever, and pain all over the body. He is too weak to walk by himself. On admission he lies in a somnolent con- dition, but can be roused easily; his speech is very indistinct, and he cannot answer questions. His temperature on admission was 100°F., and it was seen that he passed urine involuntarily, or unconsciously. The spleen is not enlarged, but some post cervical glands are enlarged slightly, one axillary gland is big, but inguinal glands not enlarged. Puncture of the cervical glands revealed trypanosomes in quantity.
His friends state that he is a farmer, and has been all his life in the Kwaia One year ago country, in a small village called Malenki, in Bai Farima's chiefdom.
he was perfectly well. He was carried to Freetown a fortnight ago; no history is obtainable as to the onset and length of his present illness. As far as I can learn, the locality is just north-east of Songo town, on the railway line, about thirty miles from Freetown. I enclose slides for examination of gland juice.
I have, &c.,
SIR,
H. E. ARBUCKLE.
TO HONOURABLE PRINCIPAL MEDICAL OFFICER, FREETOWN.
Caroline
I HAVE the honour to report on another case of trypanosomiasis. Nicol, at. 43 years, a trader, came to the out-patient department of the Colonial Hospital on 28th November, complaining of pain in the chest, swelling of the feet and loss of appetite. She was admitted into hospital that day. On admission her tem- perature was 100.4° and pulse 84. The heart was dilated, the apex beat being in the sixth interspose, just outside the nipple line; there was a systolic murmur in all the heart areas. The feet and lower part of the legs were edematous. The liver was enlarged, three fingers' breadth below the costal margin, in the nipple line; and the spleen two fingers' breadth below the costal margin. In the left side of the hypo- gastrium was a swelling, which was not tender.
There was one flat slightly enlarged gland behind the left sternomestoid, and in the right axilla several enlarged glands; no other glands palpably enlarged. There was no tremor of the tongue and only slight tremor of the fingers on complete extension. Knee jerks present but sluggish; no deep hyperesthesia. There were no signs of drowsiness or want of intelligence. Blood examination revealed the pres- ence of trypanosomes; gland puncture was not done.
Patient says she has lived all her life in the Colony of Sierra Leone; for the last seventeen years at Allen Town, about thirteen miles by rail from Freetown.
I have, &c.,
2nd December, 1913.
H. E. ARBUCKLE,
A woman,
TO THE HONOURABLE THE PRINCIPAL MEDICAL OFFICER. I HAVE the honour to report another case of trypanosomiasis. Karey, at. 36 years, came to the Colonial Hospital, Freetown, yesterday, 17th December, complaining of swelling of the abdomen, and great sleepiness. She was admitted to hospital as a probable case of trypanosomiasis. On admission she pre- sented a sleepy expression; she is fairly well clothed with fat. Nothing abnormal can be detected with abdomen or thorax. The neck has recent scars where glands have been removed; there are still a few glands in the posterior triangle of the neck which are enlarged; the axillary glands are enlarged, as are the epitrochlear; the inguinal glands are not affected. The tongue is very tremulous; there is no deep hyperesthesia. Gland puncture was done and trypanosomes found. She gives a history as follows:-She came from Comi in the Congo country, last year, as she had enlarged glands in the neck, axilla and popliteal spaces, which the natives could not deal with there. In November, 1912, she came to Freetown, where she has been ever since. In August, 1913, she had the glands removed, and since that time she began to be sleepy. In the Congo she had no symptoms at all, except the enlarged glands.
H. E. ARBUCKLE.
18th December, 1913.
THE DISTRICT MEDICAL OFFICER, Koinadugu DiSTRICT, to THE PRINCIPAL MEDICAL OFFICER, FREETOWN.
SIR,
In reply to Circular No. 14/13, I have the honour to reply as under :— 1. Sleeping sickness is known to exist in this district. The natives recognized it and fear its infectivity so much that in some instances they drive suspected cases out of the towns and from town to town. One case who came to see me lately in Kaballa during my absence on patrol, was at once driven away without even being
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