1278 



THE AFRICAN TRYPANOSOMIASES 



act upon the latent form of the trypanosome, while atoxyl would influence 

 the active form. In man this combined treatment has apparently not given 

 any better results than atoxyl alone. 



Orpiment and Atoxyl.- — This combined treatment, consisting of atoxyl and 

 an inorganic salt of arsenic such as orpiment, has been recommended by 

 Laveran and Thiroux, and has been used in man with good results. 

 The orpiment should be given in pill§, in the dose of 2 grains of orpiment two 

 or three times daily. The administration of orpiment frequently causes 

 diarrhoea. Thiroux therefore incorporates in the orpiment pills some opium. 

 Thiroux's formula is: — 



Orpiment . . . . . . . . . . . . 20 grammes. 



Extr. opii . . . . . . , . . . . . 0*40 gramme. 



Gumm. . . ^ 



Pulv. glyceriz./ " ^-s- 



To be divided into 200 pills. 



Various Dyes and Atoxyl. — Combined treatments of Mesnil's afridol and 

 atoxyl, Ehrlich's parafuchsin and atoxyl, picric acid, safranin, trypaflavin 

 and other dyes and atoxyl, have been suggested, but in man the results have 

 not been so successful as in the lower animals. 



Treatment ot Natives. — In the case of natives it is necess ry to gather them 

 into special sleeping sickness camps in order that treatment may be efficiently 

 carried out. These camps should be in some fly-free area, and should be 

 provided with a ; rained medical staff. Patients able to work should be 

 employed to raise crops for their own consumption, to supplement the diet 

 provided by the Government. 



Symptomatic Treatment. — In addition to the atoxyl treatment or 

 combined treatments, malaria and the intestinal parasites must be 

 treated if present. The patient should, if possible, be removed from 

 the area of infection and placed under good hygienic conditions and 

 on good food, and no case should be considered to be cured until the 

 injection of the blood, on more than one occasion, into susceptible 

 animals fails to infect them. 



Prophylaxis, — ^At the present time prophylaxis must be under- 

 taken on the assumption that the disease is spread from place to 

 place by man along channels of human intercommunication, and 

 from man to man by Glossina palpalis and G. morsitans, and that 

 at least in the case of C. rhodesiensis there are animals which act as 

 reservoirs of the virus. With regard to these flies, further infor- 

 mation is required as to their bionomics, though Bagshawe's and 

 Hodges' researches, as well as those of Zupitza, Sander, Minchin, 

 Kinghorn and Yorke, Carpenter, and others have thrown some light 

 on the subject. 



Before enumerating the principal prophylactic measures to be 

 recommended, we wish to draw attention to the fact that these, 

 as pointed out by Bagshawe, will be useless without the co-opera- 

 tion of the natives. This co-operation may be obtained by ex- 

 plaining to them at every possible opportunity the reason for the 

 measure taken. In this missionaries and native chiefs may be of 

 the greatest help. With this proviso we consider the following to 

 be the principal prophylactic measures: — 



Public Prophylaxis. — W^e advocate: — 



I. The formation of a Central Executive International Board, 

 with headquarters in^^ither Paris or London, 



