386 REPORT OF THE HARVARD AFRICAN EXPEDITION 
flagellates were found in them. He illustrates in a table the number of cases of 
the disease which were diagnosed in 1927 in these regions; eighteen of these cases 
were in New Beni, five on the road between Irumu and Beni, and four at the old 
Beni Mission. During the entire tour sixty-seven cases of the disease were diag- 
nosed. 
Prophylaxis and Treatment. In none of the areas, including the Semliki 
Valley, in which we travelled, did it seem to us that the abandonment of villages 
and evacuation of the inhabitants is now, with our present knowledge of pro- 
phylaxis, the most advisable procedure in the prevention of the spread of the 
disease. In the lower fertile and beautiful Semliki Valley near Old Beni, we 
found the guava, banana, and other plantations overrun and destroyed by ele- 
phants and buffalo, the houses of the old settlements in ruins, the clearings fast 
being overgrown by low brush and other vegetation, and the conditions becoming 
once more most favorable not only for wild game but for the development of 
tsetse flies. Since one is able by inoculation of several preparations [ tryparsamide, 
germanine (Bayer 205) (Fourneau 309) and even atoxyl] usually to cause the 
trypanosomes to disappear from the peripheral circulation of the patient, it 
would appear that a more conservative and efficient method of control would be 
to concentrate upon the early diagnosis and treatment of the cases in the districts 
and to allow the population to remain in such districts; but, nevertheless, to 
insist upon the gradual clearing of the jungle by them and cultivation of the land 
in the infected regions. It has been argued that the destruction of the wild game 
may cause the fly to feed more frequently on man, but in the clearing of the land 
the gradual disappearance of the tsetse fly will occur as well as of the wild game 
that perhaps may act as a reservoir for the trypanosomes. Of course such 
measures require the maintenance of an organized staff of sufficient size success- 
fully to prosecute the campaign. 
Drugs which have proved to be of great value in the treatment of sleeping 
sickness, unless the disease is well advanced, are tryparsamide, and Bayer 205 or 
Fourneau 309. At the present time a number of Belgian physicians in the Congo 
believe that Bayer 205 or Fourneau 309 cause a rapid disappearance of the try- 
panosomes in the acute stages of the disease, but these preparations are regarded 
as not so valuable in the advanced cases of trypanosomiasis as is tryparsamide. 
Maclean * has also recently called attention to the superiority of these prepara- 
tions over others in the treatment of human eases. Louise Pearce 2 who first in- 
troduced in Africa the treatment with tryparsamide of human trypanosomiasis, 
has reported upon the favorable results obtained. With all preparations which 
contain organic arsenic there is, of course, danger to the optic nerve, and hence 
dosage should be carefully regulated. We saw several patients who, while they 
had been successfully treated for trypanosomiasis with tryparsamide, had be- 
come blind from the toxic effects of the drug, and the blind, uneducated African 
is, perhaps, better dead, for what has he left in life? 
‘1 Maclean: Ann. Trop. Med. and Parasit. (1929), XXIII, 337. 
2 Pearce: Science (1925), LXI, 90. 
