178 EEVIEW — TROPICAL MEDICINE, ETC. 



Sleeping the nature of the disease, how it was spread, the importance of clearing away the undergrowth in which the 



Sickness— " Kivu " lived, and the urgent need for segregation of tliosc actually sick, while they enlisted by every means ia 

 contimied *'*°''' po^t:'' t'"^ active co-operation of the chiefs. In regard to personal prophylaxis, the European, even when 

 living within the dangerous area, was but little exposed to infection if he used his knowledge intelligently. 

 His bungalow should not bo built near the water's edge or close to the native compounds. The ground for 

 a consideraljle area round his station should be cleared and, what was more difficult, kept clear of undergrowth, 

 especially of bushes, in the shade of which the tsetse fly was found. His dwelling should be protected by 

 gauze screens or tine wire netting and his bed by a mosquito net, while the native porters who brought his 

 water from the lake should not be allowed to enter the house, for tsetse flies often buzzed persistently round 

 the heads and shoulders of those porters and followed them for long distances. Tsetse flies had been discovered 

 inside European bath-rooms at Entebbe at some considerable distance from the lake — doubtless introduced in 

 that way. Koch told him that he and the officers of his expedition were simply depending on living away from 

 the water's edge, which the tsetse fly frequented— their camp was some 400 feet above lake level— and on 

 wearing white garments, since the fly was repelled by white but attracted by dark clothing. 



As regards the threatened portion of the Sudan, the work carried on by Major Dansey 

 Browning and Captain Ensor has furnished a great deal of information. A consideration of 

 the latter officer's lengthy and able report has been undertaken by Bimbashi Archibald, who, 

 in view of his experience in Uganda, is well qualified to comment upon the various points 

 discussed (Third Report). 



At the present moment, and from a practical standpoint, treatment may fairly well be 

 summed up in the word " atoxyl." 



Koch's method of administration is to give half a gramme of the drug by subcutaneous 

 injection on two successive days, and after ten days to repeat the injections. In 20 per cent, 

 of cases so treated the trypanosomes disappeared permanently, but in other instances they 

 returned. Hence it is necessary to repeat the treatment every ten days during two months. 

 It is then suspended for an indefinite time and, on any return of symptoms, repeated, if 

 necessary, every two months. Eecent observations, however, have shown that cases 

 supposed to be permanently cured do show relapses, and this without any possibility of 

 re-infection from tsetse fiy (Archibald). 



The disappearance of trypanosomes from the blood after atoxyl injections is attributed 

 by Koch to a state of immunity produced by an absorption of dead parasites. 



Atoxyl is very effective in diminishing the size of the enlarged lymph glands, but one of 

 its drawbacks is that it is apt to produce permanent blindness if given in excessive dosage. 



Hence acetylated atoxyl has been introduced and used by Ehrlich, Nierensteini and 

 others. It is an nntipyrine containing arsenious acid. Mention may also be made of the 

 Liverpool method of using atoxyl combined with corrosive sublimate- or with orpiment, as 

 tried by Laveran and Thiroux,^ who have obtained good results in animal experiments 

 by this procedure. 



Antimony salts were introduced by Plimmer and Thomson, ^ and stated to be better than 

 atoxyl, but latterly less has been heard of this method. 



Other remedial measures and accounts of experimental work carried on in the Sudan 

 will be found in the special article on "Trypanosomiasis" (Third Eeport),'' but papers of 

 value are those by Boyce and Breinl" and by Manson.' "The latter's conclusions of his 

 results, as regards the treatment of trypanosomiasis in Europeans by atoxyl and other drugs, 

 are here quoted : — 



1. Trypanosomiasis in man is not necessarily a fatal disease. 



2. Atoxyl has a marked effect in checking the clinical manifestations of the infection, and in causing 

 the parasites to disappear from the peripheral circulation. 



3. Notwithstanding continuation of atoxyl treatment, parasites may reappear again and again at uncertain 

 intervals, and usually concurrently with a rise in temperature. 



' Nierenstein, A. (July 27th, 1907), " The Treatment of Trypanosomiasis." Lancet, Vol. II. 



^ Moore, Ben]"., Nierenstein, M., and Todd, J. L. (February 1st, 1907), "A Note on the Therapeutics of 

 Trj-panosomiasis." Annals of Tropical Medicine and Parasitology, Series T.M., Vol. I., No. 1. 



' Laveran, A., and Thiroux, A. (February 25th, 1908), " Recherches sur le traitement des Trypanosomiasis." 

 An7i. dc VInslitut Pasteur, Vol. XXII. 



■• Plimmer and Thomson (November 7th, 1907), "Further Results of the Experimental Treatment of 

 Trypanosomiasis." Procealings of the Royal Society. 



" Much curtailed owing to the losses sustained by fire. — A. B. 



" Boyce, Sir R., and Breinl, A. (March 2nd, 1908), "Atoxyl and Trypanosomiasis." Annah of Tropical 

 Medicine and Parasitology, Series T.M., Vol. II., No. 1. 



■< Ibid. 



