SLEEPING SICKNESS 
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maintained and it would bo advisable that such cleared areas be used for the purpose of I'lanting of 
planting potatoes or even citronella grass. In Entebbe, the cleared areas on tlie foreshore 
of Lake Victoria have been planted with citronella grass with markedly beneficial results. 
The process of clearing these infected fly areas will be attended with more or less 
danger to the natives employed for this purpose. This danger undoubtedly occurred in the 
clearing operations in Uganda, natives acquiring sleeping sickness from the bites of infected 
hies. It would be interesting to observe whether some means could be adojited to overcome 
this danger of being infected while clearing a hy-infeeted area. The natives employed 
might have their skins covered over with some form of oil or ointment, containing a powerful 
deodorant which would act as a deterrent to the attacks of the hy. This is a line of 
research wliich appears not to have occupied sufficiently the minds of those engaged in 
sleeping sickness investigations. If such a deodorant was found successful in warding off 
the attacks of the hy, its universal use by the natives would certainly tend to diminish 
sleeping sickness without interfering with the trade of the country. 
As regards the important question of the diagnosis of sleeping sickness in its early 
stage, i.e. before the somnolent stage has been reached, my experience of gland puncture 
performed in several hundred natives, goes far to show that it is not by any means a reliable 
one, and I would suggest that all medical officers, engaged in sleeping sickness investigations, 
should be provided with a centrifuge, and all doubtful cases should have one cubic centimetre 
of the blood removed into a test-tube containing a I per cent, sodium citrate solution, the 
mixture centrifuged for ten minutes, and the superficial layer of the blood examined for the 
presence of trypanosomes. On several occasions Koch’s method of examining the blood for 
trypanosomes was employed by me, but without success. This may have been due to some 
error in my technique. In Busoga, where filariasis is more or less omnipresent, mere 
palpitation of the gland substance was not sufficient for a diagnosis, and frequently on gland 
puncture typanosomes and filaria were found co-existing in the same gland juice. 
Several cases which one examined in Uganda showed clinical signs and symptoms of 
the disease, and yet no trypanosomes were found on gland puncture and vice versa. It is 
hardly necessary to state that all such cases were treated as cases of sleeping sickness. 
Observations have shown that the G. palpalis is more or less omnivorous as regards 
vertebrate blood, and, as a further means of inhibiting the increase of the fly, all animals 
which offer the fly a means of sustenance should be destroyed. Another means of 
compassing fly destruction would be the importation of some bird or insect that would feed 
upon the tsetse. Such remains to be found. 
As regards the medicinal treatment of sleeping sickness, atoxyl as a curative agent, in Medicinal 
my hands, ])roved a failure. Cases that looked at first promising invariably relapsed. One 
notable feature of the action of this drug was its effect on the enlarged lymphatic glands, 
which appeared to undergo fibrous atrophy, and thus, directly or indirectly, the drug 
eliminated the trypanosomes out of the gland substance. They persisted, however, in the 
circulating blood. Used in combination witli mercury, atoxyl gave disappointing results. 
One other medicinal agent, tartarated antimony, was used without success, but it scarcely 
had sufficient trial to warrant its condemnation. It was a melancholy fact that out of 
several hundred oases under treatment not a single cure resulted. It must be mentioned, 
however, that one was contending, not only against the effects of sleeping sickness, but those 
of famine also, and the combination went far to produce such discouraging results. 
In spite of the accounts by other observers -of the effects of drugs as curative agents in Serum-therapy 
this disease, judging from results, one is led to the conclusion that serum-therapy should be 
given a more extended trial in connection with the investigations for the discovery of a 
curative agent in sleeping sickness. 
