1911.] Agent in a Case of Human Trypanosomiasis. 157 



entered the Protectorate vid Chinde and Blantyre. Left Blantyre for 

 Angoniland on June 27, 1910. July 1, arrived at Mlanda where he 

 remained four days. July 6, travelled to Mpatso vid Mpungi, and Dedza, 

 thence to Mt. Dzobwe, 40 miles west, and back. July 19, left Mpatso for 

 Diampwi, where he remained until the 23rd. On the 24th he arrived at 

 Mkoma. July 28, reached Mvera, where he remained for about a fortnight. 

 During his stay here he saw a case of trypanosomiasis. The patient was 

 lying in the open air and Mr. E. did not approach within several yards. 

 August 13, left Mvera on a shooting trip and spent the next day at 

 Maganga's village on the lake shore. On August 15 he went to Patsamjoka, 

 where he remained for two days. August 17, arrived at Nsarula on the 

 Lintipe river. Here he was severely bitten by tsetse (species not recognised). 

 August 18, returned to Mvera. August 19, arrived at Kongwe and com- 

 plained that the bites in the neck were painful ; the next day he felt ill. 

 August 23, neck examined by one of his companions, and a " lump " about 

 the size of a shilling, rather light in colour and surrounded by a dark purple 

 ring, was found in the sub-occipital region, where he had been bitten by fly 

 and where he had experienced pain ever since. During the next few days 

 patient complained of severe headache. Temperature 102 - 5 — 104° F. Neck, 

 swollen and painful; face, puffy. August 31, blood examined and try- 

 panosomes found in large numbers. 



From the above record of the patient's movements whilst in ISTyasaland 

 there appears to be little doubt that he was infected in the Dowa sub-district, 

 possibly in the neighbourhood of the Lintipe Kiver, on August 17. 



Treatment. — For the first five weeks 6 grains of atoxyl were injected 

 intramuscularly on Thursday and Friday of each week. For a second period 

 of five weeks 3 grains of atoxyl were given every third and fourth day. From 

 the 11th to the 18th week soamin (10 grains) was administered on two succes- 

 sive days in every other week, and perchloride of mercury once in the 

 intervening weeks. As the injections of mercury were very painful and 

 were not followed by any improvement, they were discontinued and soamin 

 alone administered in 10-grain doses every Thursday and Friday. 



At first the patient's condition steadily improved. On September 24 there 

 was a sudden attack of adenitis, involving the posterior cervical glands of both 

 sides. Since, there has been a gradual but progressive anaemia, with loss of 

 strength and weight. A characteristic rash developed on the 78th day, but 

 disappeared after a few days. It has reappeared on five or six occasions 

 since. There have also been several subsequent attacks of adenitis. 



Temperature. — Marked periodicity has been a characteristic feature 

 throughout, the temperature rising to 103° to 105° F., and .falling again to 



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