i 7 4 MEDICINE 



"The effect of the depopulation of the country was to make a two-mile area on the north 

 shore of the lake practically a game preserve, frequented by many kinds of antelope, hip- 

 popotarrii, and wild pig. The late Commission set themselves the task of finding out whether 

 this game, and especially the antelope, were capable of harbouring the parasite, being thus 

 a perpetual reservoir from which the fly could get fresh infective material. Very complete 

 experiments were carried out, and it was found that antelope are very readily infected with 

 trypanosomes from flies previously infected with human trypanosomiasis, and that the 

 blood of the artificially infected antelope again infects other susceptible animals if the 

 Glossina palpalis acts as an intermediary carrier. In no single case, among many animals 

 experimented on, was the health of the antelope in any way affected. From a paper pub- 

 lished by the Royal Society in February 1912, we learn that one of Sir David Bruce's arti- 

 ficially infected antelopes still contains, after 327 days, Trypanosoma gambiense in its 

 blood. 



"It has now been proved that antelope living in fly-areas in N. Rhodesia and Uganda are 

 naturally infected by the two human trypanosomes of sleeping-sickness. This is a sufficient 

 explanation for the continued infectivity of the fly round the lakes. It is important to find 

 out whether other wild game can, and do, act as a host of the parasite. It has already been 

 suggested that the wild game in sleeping-sickness areas should be destroyed, but the British 

 Government is unwilling to authorise any such wholesale extermination of animals, which 

 might be wanted for food, until it has been more satisfactorily proved that the game are 

 the chief reservoir of the parasite. 



"... Every fresh discovery tends to increase the complexity of the problem how to 

 deal with the question of prevention. It is now known that the fly remains infective, after 

 feeding on infected blood, for 96 days, and possibly for the entire course of its life; that not 

 only the Glossina palpalis, but also the far more plentiful Glossina morsitans is implicated; 

 and now we must assume that an inexhaustible supply of infective material can be drawn by 

 both these flies from innumerable reservoirs among wild game, and also among cattle and 

 other domestic animals, because they can be infected so easily by experiment." 



Happily, the work of protective administration has not been annulled by these further 

 problems of science: and good work has been accomplished, under conditions of the ut- 

 most difficulty, toward holding the disease in check. It is worthy of note, that since the 

 way in which the disease spreads was discovered, the annual death rate from sleeping- 

 sickness on the Uganda shores of the Victoria Nyanza has fallen from 8,000 to 500. 

 There are several causes for this happy reduction; but chief among them may be reck- 

 oned the present measures of protection and prevention to which men of science have been 

 led by the help of experiments on animals. 



Again, though no specific treatment has yet been discovered for the disease, such as 

 quinine for malaria or antitoxin for diphtheria, there is much to be gained by treatment, 

 if the conditions allow of continuous treatment. Unhappily, these favourable condi- 

 tions, as Dr. Sandwith points out, are to be obtained in the few European cases, not in 

 the vast multitude of the native cases: 



"The native does not usually come under treatment till he has developed the final and 

 most serious symptoms, when his fate is sealed, and when the treatment can do no more than 

 alleviate his sufferings and make his death less painful. Even if the negro presents himself 

 for treatment at an earlier stage, and is apparently cured, he returns to the infected area, 

 and his naked body is again a target for every hungry tsetse-fly, so that he may succumb to 

 a fresh infection at once. 



"But in the European the outlook is more hopeful. In most cases he comes to the doctor 

 when he feels the first symptoms, and directly trypanosomes are detected in the blood he 

 is sent out of the country and is safe from fresh infection. He submits to continuous treat- 

 ment, and does not attempt to escape from his advisers as the negro does when his con- 

 dition begins to improve and he yearns for liberty from hospital confinement." (Sandwith, 

 loc. cit.) 



Sir Patrick Manson has reported two European cases: one, after 2| years of treatment, 

 has gained 30 Ibs. in weight, and, though not absolutely cured, is well enough to walk 

 three miles without fatigue: another, a lady, is in good health more than ten years after 

 the onset of the disease. Among European cases which have ended fatally, there is the 

 case of Lt. Forbes Tulloch, R.A.M.C., of the Royal Society's sleeping-sickness Commis- 

 sion in Uganda: he cut himself, dissecting an infected rat; trypanosomes soon appeared 

 in his blood, and, after an unusually rapid course, the infection ended in death (June, 

 1906), within a few months. If any student of tropical medicine wishes to form an 

 estimate of the volume of work done in the last few years on sleeping-sickness, he must 



