1904.] en Sleeping Sickness in Uganda. 511 



sleeping sickness lias been endemic for au unknown time. It seems, 

 then, quite probable that some of these natives, brought in with the 

 remains of Emin Pasha's expedition, may have brought the disease 

 into Busoga, and that from this focus it slowly spread to the neigh- 

 bouring population. Be that as it may, the disease broke out in 

 this part of the country some time between 1896, according to 

 Dr. Hodges, and 1901, when the disease was definitely diagnosed, and 

 in a short time reduced a populous and richly cultivated country to a 

 depopulated wilderness. 



Now, having discussed the introduction of sleeping sickness into 

 Uganda, let me for a few minutes (]raw your attention to the disease 

 itself. Sleeping sickness is a curious disease, and is essentially a 

 disturbance of the functions of the brain. A slow chronic inflam- 

 matory process takes place in the brain substance, which after a time 

 gives rise to the peculiar symj^toms of the disease. But for a long 

 time, sometimes years, the preliminary symptoms of sleeping sick- 

 ness may be of so slight a character that no one suspects there is 

 anything wrong. That is to say, the sleeping sickness patient may 

 go about doing his ordinary work for years without his friends 

 noticing there is anything the matter. But gradually a slight change 

 in his demeanour becomes evident ; he is less inclined to exert him- 

 self ; he lies about more during the day, and at last his intimates see 

 that he lias the first symptoms of this absolutely fatal malady. 



The face is sad, heavy, dull-eyed and apathetic. The man is, how- 

 ever, well nourished, and this is the rule if the patients are well 

 nursed and fed. If you examine the man's pulse, you find it rapid 

 and weak. If you ask him to hold out his hands, you find that they 

 are weak and tremulous. When asked to walk, his gait is weak and 

 uncertain. When he answers a question, his voice is weak, indistinct 

 and monotonous. The symptoms gradually deepen, and after several 

 months the patient is unable to walk, unable to speak, and unable to 

 feed himself. He is then, of course, altogether confined to his bed, 

 lying in an absolutely lethargic condition all day long. It is in this 

 stage that the sick are often neglected by their friends : they remain 

 unfed, and become emaciated. 



In regard to other symptoms, it may be mentioned that during 

 the illness the temperature has shown some elevation of an irregular 

 character, often normal in the morning and rising to 102° or so in the 

 evening. (Fig. 2.) 



Here, you see the irregular course of the fever, and also that 

 during the last few weeks of life the temperature falls several 

 degrees below the normal line, showing the gradual extinction of the 

 vital forces. 



This, then, is a short description of this peculiar disease called 

 sleeping sickness ; and now the question arises, what is it that causes 

 this peculiar disease, and gives rise to these curious symptoms ? I 

 may pass over without notice the various theories which have been 

 held up to the present time to account for this disease, and ask your 



