290 APPENDICES 



Victoria, added yet another terror to the already 

 gloomy outlook on sleeping sickness. He found a 

 large number of cases in districts where the tsetse-fly 

 was absent. The majority of the cases were un- 

 doubtedly imported, occurring in people who worked 

 in the rubber industr3' in forests along the lake-shore, 

 where tsetse-flies abounded. But fifteen of the cases 

 could not by any possibility have been imported. 

 All were women, and all were wives of men emplo3'^ed 

 in the rubber industry in a tsetse-fly area. Assuming 

 that no other biting insects than tsetse-flies are 

 capable of transmitting the disease, the only tenable 

 hypothesis is that these women contracted it from 

 their husbands by the act of coitus. If Professor 

 Koch's observation is correct, the prospect of eradi- 

 cating sleeping sickness is a sufficiently remote one, 

 as not only can the disease be transmitted by a widely 

 distributed fly, but it also belongs to the category of 

 venereal diseases, and experience of many centuries 

 has shown the difficulty of stamping out diseases of 

 that class. 



The diagnosis of sleeping sickness is best made 

 microscopically. It may be confused with beri-beri, 

 but the latter is a disease of the peripheral nervous 

 system, and is non-febrile, while sleeping sickness is 

 a disease of the central nervous system and is febrile. 

 Microscopically, it is often difficult to find the 

 trypanosomes, which are alwa3^s rare, and occasion- 

 ally absent from the peripheral circulation. It is 

 better to puncture a lymphatic gland and examine 

 some of the aspirated lymph. 



The treatment of sleeping sickness is a subject about 

 which there are widely different opinions, but it is 

 impossible to speak very hopefully at present of any 

 of the therapeutic methods which have been sug- 

 gested. The greater number of authorities have more 



