THE SLEEPING SICKNESSES 



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trypanosome affections; and Kopke, in 1906, tried it in human 

 beings affected with sleeping sickness. 



The beneficial action of atoxyl in sleeping sickness was further con- 

 firmed by Broden, van Campenhout, Manson, Koch, and many 

 others. In 1907 Ehrlich and his pupils, Franke and Roehl, dis- 

 covered the very important fact that trypanosomes may, after a 

 time, become atoxyl-resistant. Ehrlich therefore suggested mixed 

 or alternating treatment with various preparations, and the same 

 suggestion, though based on different grounds, was made by Moore, 

 Nierenstein, and Todd. Plimmer and Thomas introduced tartar 

 emetic, which has been found to be very beneficial, especially if 

 associated with the atoxyl treatment. 



Geography and Epidemiology. — ^The disease was first noticed on 

 the West Coast of Africa at Sierra Leone, but was soon found to 

 extend far southwards, and was also noted to be imported from this 

 endemic area at times to the West Indies, where, however, it soon 

 died out, becoming neither epidemic nor endemic. This fact clearly 

 proved that, though the disease may be introduced by man along 

 channels of intercommunication into a strange country, some other 

 factor is necessary before it can spread from the infected new-comer 

 to the inhabitants. This factor we now know to be a tsetse-fly. 



In 1882 the disease had a geographical distribution from Senegal 

 to Loando, and also to the islands of the Gulf of Guinea. Gradu- 

 ally, as civilization spread, it became known that the disease was not 

 confined to the coast, but extended far inland. Thus, in 1898 it 

 was known to be at Jebba, on the Upper Niger, and at the Stanley 

 Falls, on the Upper Congo. In the meanwhile Stanley had travelled 

 across Africa with a large number of Congolese followers, and had 

 relieved Emin Pasha and his people at Wadelai, on the Victoria 

 Nile. These followers of Emin Pasha, together with some of Stanley's 

 expedition, who had settled in the country about Kavah, to the 

 west of the Albert Nyanza, were brought by Sir F. Lugard, for 

 political reasons, to Busoga and Uganda. Christy and Hodges 

 believe that the disease was carried from the Congo by Stanley's 

 men, and that they and Emin Pasha's people brought the disease 

 with them into Busoga and Uganda when they were moved from 

 Kavali. But the fact is clear that when, in 1900, the Cooks first 

 noticed the disease in Uganda, it was widespread, and had been 

 there for some time, and it seems probable that Busoga was infected 

 in 1896. Certainly, in 190 1, Mengo, the Sese Islands, and the 

 western shores of the Victoria Nyanza, were infected, and the disease 

 spread in 1902 to the eastern shores and to late German East Africa. 



In 1904-05 Dutton and Todd found that it had become widely 

 disseminated throughout the Congo Free State, spreading by human 

 agency along trade routes, and expressed the opinion that before 

 long it would pass from the Congo into Eastern Rhodesia. Since 

 then sleeping sickness has been found in that country, though, 

 the trypanosome found in Rhodesia being a different species, it is 

 more probable that the disease has been endemic there, and not 



