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524

TRYPANOSOMIASIS IN THE WEST AFRICAN REGIMENT, SIERRA LEONE.

By CAPTAINS H. W. GRATTAN AND E. W. COCHRANE. Royal Army Medical Corps.

HITHERTO, trypanosomiasis has not been regarded asa Sierra Leone disease. Cases have been imported from time to time from endemic areas, but we believe that we are now reporting trypanosomiasis for the first time in the West African Regiment, Sierra Leone. One of the cases is of special interest on account of his having spent all his life either in the Colony or Protectorate of Sierra Leone.

Manson, in describing sleeping sickness, says that Sierra Leone is one of the places in West Africa where the disease is said to be unknown. The Hon. W. T. Prout, C.M.G., Principal Medical Officer, Colonial Medical Service, Sierra Leone, who has been in the Colony for many years, says that although he, has seen many cases of sleeping sickness in Sierra Leone, he cannot recollect one in which the patient had not come from one of the well-recognised endemic areas, and that he has never regarded the disease as endemic in Sierra Leone. Laveran and Mesnil describe the Hinterland of Sierra Leone as an endemic area. The Annual Reports of the Army make no reference to the existence of the disease amongst the troops in Sierra Leone or elsewhere.

In May, 1905, Captain J. V. Forrest, R.A.M.C., discovered a trypanosome in the blood of a private of the West African Regiment, and to this officer the credit is due of having first recognised the disease in a patient who has never been out of Sierra Leone. ,Ve take this opportunity of thanking Dr. J. L. Todd, of the Liverpool School of Tropical Medicine, for having demonstrated to us the value of gland palpation and puncture as a means of diagnosis.1 It has proved to be the simplest and most certain method. By following this technique we were enabled to pick out fresh cases in the West African Regiment, and many others amongst the civil population.

The Wesp African Regiment consists of one battalion, with

I [This useful means of diagnosis was first discovered and, described by Captain Greig, LM.S., and Lieutenant Gray, R.A.M.C., Sleeping Sickness Commission, Proceedings of the Royal Society, vol. lxxiii., page 455, 1904.--;-ED.]

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H. W. Grattan and E. W. OOGhrane 525

about a thousand native rank and file, with European officers and Colour-Sergeants. Theoretically, there are four officers per company, but owing to the absence of at least one-third of the total number on leave, there are generally only from two, to three officers per company, in times of peace. The strength of European Colour· Sergeants is eighteen, which allows for one per company, a Sergeant-Major, and those on leave. The regiment is recruited in Freetown, and until quite lately" recruiting agents" have not been sent out to the Protectorate, since the supply of good recruits has always exceeded the demand; recently, however, men have been sent out to a district to procure recruits from some particular tribe. The men enlisted are not, except in a few cases, natives of the Colony of Sierra Leone, but come from the Protectorate, having probably arrived in Freetown as carriers, or with the intention of joining the regiment.

The Colony of Sierra Leone consists for' the greater part of a peninsula, and is about 30 miles in length, with an average breadth of 20 miles. The Protectorate, which is roughly rectangular in shape, is about 170 miles from east to west, and 200 miles from north to south; it is bounded on the north and east by French territory, and on the south by Liberia.

The chief tribes represented in the West African Regiment are: Timini, 33 per cent.; Mendi, 37 per cent.; Susu; 6 per cent. ; Lokko, 5 per cent.; Joliffes, 3 per cent.; Creoles, 1·5 per cent.; other tribes in small numbers, 10·5 per cent. The Timini country extends from the Colony towards the northern part of the Protectorate, and the Mendis inhabit the part stretching towards

\ the south-west. The Lokkos come from the central part of the Protectorate, and the Susu, J oliffe, and several other smaller tribes come from its borders. As the international boundary has not been fixed with any regard to the tribal divisions, a tribe may find itself situated partly in French and partly in British territory. This accounts for the fact that there are several men now serving in the Regiment who come from the French country, and cases have occurred of men enlisting who had previously served in the French Colonial Forces. The small number of " Creoles" (descendants of liberated slaves and inhabitants of Freetown and its vicinity) is accounted for by the fact that they are specially enlisted for the Band; any thus enlisted must be able to read and write.

An extract from the notes made by the medical officers who were in charge of C,aptain Forrest's case at different times might be of interest. The first notes are by Captain J. V. Forrest, who

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526 rPrypanosomiasis in the West African Regiment

was stationed at Mabanta, Sierra Leone Protectorate, in medical charge of the company of the West African Regiment to which the man belonged.

CASE OF PRIVATE Mo MO YETO, WEST AFRICAN REGIMENT .

. "Mabanta, June 13th, 1905.-No. 2678 Private Momo Yeto, "Vest African Regiment, reported sick on May 30th, 1905, about a week after his arrival from Freetown, complaining of 'fever.' His temperature was 101° F., and smears of his blood were taken and stained with Leishman's stain, but no malarial parasites could be found. On examination' of fresh blood one trypanosome was discovered. This led to further examination of fresh blood specimens, and on most days actively motile trypanosomes were seen, and they were also found in stained preparations.

" The patient is a recruit of about nine months' service in the West African Regiment. He is of slight build, and his age is stated to be 22 years. In appearance he is dull and lethargic, and there is some puffiness of his eyelids. The clavicles are prominent, and his arms are wasted and tremulous. He says that he has got thinner of late. His tongue is flabby, furred, and deeply cracked around the edges. His Colour-Sergeant says that he is of no use on parade as he is 'all of a tremble,' and can hardly hold his rifle. D nfortunately, I have been unable to obtain any further information from his N.C.O.'s or comrades with regard to any changes which may have taken place in his character or disposition during the last few months, as he was transferred to his present company about a fortnight before coming under my notice. The superficial cervical glands are enlarged, those in the groin and axilla are normal in size. The spleen is not enlarged. There is a soft, blowing systolic murmur to be heard over the heart's apex. For four days after admission his temperature rose at night to 101° F., and then gradually dropped to normal. Since then there has been an occasional rise of temperature, the highest point reached being 100'2° :E'. Blood count: Red blood corpuscles, 4,200,000 per c.mm. ; white blood corpuscles, 8,750 per c.mm. Stained films show marked increase of eosinophiles.

"Personal history, as far as obtainable: He belongs to the town of Yonni Banna, in the district of Ronietta, Sierra Leone Protectorate, about thirty miles from the railway station of Moyamba. The place is marked on the Ordnance map .. He appears to have spent all his life in that neighbourhood until he went to enlist at

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H. W. Grattan a~~d E. W. Oochrane 527

Wilberforce about nine months ago. He says that he has never been ill before. I am transferring him to Freetown for further observation and invaliding."

The man was sent from Mabanta to Port Lokko, on June 14th, 1905, on his way to Freetown, and was seen by one of us (E. W. C.) on the following day. He had been carried in a hammock the twenty-five miles between these two stations, as he was only able to walk short distances. He was dull and stupid in appearance, but answered questions intelligently, although his speech was slow. His blood was examined on both June 15th, 1905, and June 16th, 1905, but no trypanosomes were found. As he was sent on to Freetown on June 16th, 1905, there was no further opportunity for investigation at that time.

After his arrival at Wilberforce, on June 19th, 1905, the following notes were made by Captain E. W. Bliss, R.A.M.C. :-

June 19th, 1905.-This man arrived here to-day as a sick transfer from Mabanta. The patient stands in rather a listless manner; upper eyelids markedly dropsic~l. Tongue furred, . cracked· and deeply indented by the teeth, and very tremulous. Lower lips also tremulous, and fine tremors of hands and forearms are present. No tremors of lower limbs. Patient states that he has wasted, and this is corroborated by other opinions. He sleeps a good deal during the day, and does not rouse until after he has been spoken to for some moments. Nothing else of importance to be made out by examination. ..

June 26th, 1905.-The temperature has been of an intermittent character for last two days. Tongue cleaner. Tremors and other symptoms remain the same. Liq. arsenicalis, m. v., four times a day, has been given for three days. Blood count by one of us (H. W. G.): Red blood corpuscles, 4,228,000 per c.mm.; white blood corpuscles, 11,160 per c.mm.; hreinoglobin, 60 per cent. (Gowers). Differential count (500 cells): Polynuclears, 52 per cent.; lymphocytes, 33 per cent.; large mononuclears, 6 per cent. ; eosinophiles, 9 per cent.

June 30th, 1905.-Patient seems more shaky and weaker this morning. Temperature is subnormal. Takes his food well and sleeps a good deal. After the arsenic, trypanosomes disappeared from the peripheral blood.

July 2nd, 1905.-He still seems very weak; is getting milk, beef tea and arrowroot as extras, and a mixture containing digitalis and strychnine.· Pulse good. Complains of epigastric pain. Ankylostoma ova were found in stools.

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528 Trypanosomiasis in the West African Regiment

July 4th, 1905.-Rather better. Thymol, gr. x., given every two hours for four doses. Tremor of tongue, hands and forearms unchanged.

July 5th, 1905.-Patient very weak this morning. Pulse small, weak, but regular. Rather drowsy. Complains less of abdominal pain. Takes. nourishment indifferently.

July 10th, 1905.-Sleeps much during the day, and has to be roused to take food, but his appetite is fairly good. Is not quite so weak.

July 18th, 1905.-The only change since last note is that there is an increasing tendency to sleep. He takes all nourishment when roused. Tongue remains red, raw, cracked and deeply indented by the teeth. The tremors of the hands are not so marked.

July 20th, 1905.-No trypanosomes found in peripheral blood 'yesterday. Condition unchanged.

July 26th, 1905.-This morning a large number of trypanosomes are present in the blood; they are very actively motile. Tremors of hand and tongue less marked. Sleeps nearly all day.. Cervical glands still enlarged. Gait staggering. Muscular weakness more marked.

August 3rd, 1905.-Yesterday no trypanosomes to be found in blood, and since then his condition has quite changed. He is brighter and much less sleepy; he walks and stands better. Temperature normal. Appetite good. Arsenic has been discontinued.

August 8th, 1905.-Since the afternoon of 5th inst. his temperature has been up again; is now 99'S F. His condition is slightly changed, as he is more drowsy. Hands, lips and tongue more tremulous. Trypanosomes found in fresh blood specimens to-day. Blood count by one of us (H. W. G.) : Red blood corpuscles, 3,796,000 per c.mm.; white blood corpuscles, 10,020 per c.mm.; hffimoglobin 67 per cent. (Gowers).

August 11th, 1905.-Chrysoidin, T~ grain, hypodermically at 5 p.m. No trypanosomes to-day in blood from finger. No marked change since last note.

August 17th, 1905.-Injections of chrysoidin given daily since last note. Condition seems to be somewhat improved. Patient less sleepy and has talked to other men in his ward, which he had not previously done.

August 19th, 1905.-Injections have been continued and the improvement seems to be maintained. " Gland juice" taken yesterday, but no trypanosomes found in wet or stained specimens.

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H. W. Grattdn and E.' W. Oochrane 529

August 20th, 1905.-Dr. J. L. Todd saw the patient to-day and demonstrated the presence of trypanosomes in the cerebro-spinal fluid by lumbar puncture.

August 21st, 1905.-This morning patient got up and washed himself. His gait is very staggering; tongue cleaner and less tremulous.

August 28th, 1905.-Patient appears to be getting more drowsy again. The tremors are very well marked and the cervical glands are increasing in size. Case handed over to Captain Cochrane, R.A.M.C.

August 29th, 1905.-The following notes were made by one of us (H, W. G.): The submaxillary, submental and posterior sterno-mastoid glands are enlarged, also the axillary, inguinal and femoral; enlargement of the latter being most marked. The left epitrochlear gland is about the size of a hazel-nut. The skin is dry. There is slight tremor of both hands and the grasp is weak and enfeebled. There is a general wasting of the muscles, accompanied by muscular weakness. The tongue is tremulous. Tactile sensibility is reduced. Sensation to pain is diminished and delayed. Thermic sensation normal. The patellar reflex is present, but obtained with difficulty. No ankle-clonus. Abdominal reflex present, plantar absent. Cremasteric and conjunctival reflexes diminished, the latter markedly so, as he allows the finger to rest on the eyeball for a second or more before winking. Pupils equal, 3 mm., react sluggishly to light and accommodation. No nystagmus. Pallor of both discs noted. Ptosis present. Hearing normal. Voice low and monotonous. Is in a very low and depressed mental condition. Complains of pain below ensiform cartilage, a symptom of ankylos~ tomiasis. Stools examined. Ova of Ankylostomum duodenale present. On examining a stool preparation with a {-th objective the whole field was seen to shimmer with active movement; this was due to a number of flagellate bodies, which were swimming about in every direction.

August 30th, 1905.-Thepatient lies in bed apparently asleep, and presents the typical picture of a case of sleeping sickness. If called by name he merely answers with a grunt, but if told to open his mouth and put out his tongue will do so. He can be made to sit up in order to take food, but has to be fed. His body is wasted but not emaciated. Skin rough and dry. Heart and lungs normal; no cardiac bruit can now be detected. Pulse 90, fairly strong. Liver not enlarged. Spleen cannot be felt. Tongue moist, but cracked and furred. Urine normal. Tremors of tongue and arms

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530 Trypanosomiasis in the vVest African Regiment

well marked. Pupils equal and moderately dilated; they react to light. General enlargement of superficial glands without any surrounding inflammation, but the largest to be felt is not more than l inch by t inch.

The injections of chrysoidin were stopped on August 30th, 1905, and arsenic by the mouth substituted. On September 11th, 1905, it was noted that he was gradually getting worse, as, in addition to becoming more comatose, he commen.ced to lose control of his sphincters and pass motions and urine under him. Up to this time he had always made his wants known.

No trypanosomes were found by blood examination on September 6th and 11th, 1905, although he had fever on both occasions.

On September 25th, 1905, his condition was little changed; 10 cc. of cerebro-spinal fluid were withdrawn by one of us (H. W. G.), and trypanosomes were found in it. They were also found by puncture of a cervical gland, but none were seen in the blood.

October 16th, 1905.-His temperature, which, up to this date, had varied between normal and 101'4° F., rose to 103'6° F. at 8 a.m. His pulse was 120 and weak. He had been constipated for some days, in spite of calomel and sulphate of magnesium, and was giyen a simple enema with fair result. During the day he commenced to hiccough, but this symptom disappeared at night. Evening temperature 103'4° F.; pulse 140, very weak and thready. His blood was examined in the morning with negative result.

October 17th, 1905.-Morning temperature 98'6° F.; pulse 120, stronger than yesterday. Hiccough still comes on at times. On the morning of October 18th, 1905, there was an apparent improvement in his condition, but after mid-day his temperature began to rise and at 4 p.m. was 105'6Q F. His pulse became more rapid and weaker, and he died at 5.40 p.m.

Post-mortem Examination Fourteen Hours after Death.-Body considerably wasted. Skin rough and dry.

Brain.-Membranes normal. Weight, forty-eight ounces. Surface congested and small vessels markedly injected. About three ounces of cerebro-spinal fluid escaped whilst removing the brain. Cerebro-spinal fluid somewhat cloudy and of a pale straw colour. Pituitary body congested. Cribriform plate of ethmoid very thin and transparent, upper surface appeared more concave than normal. No pus in ethmoidal cells. White matter of brain slightly congested. Posterior cornua of lateral ventricles appeared to be dilated. Choroid plexus congested and about three times as large as normal.

Lungs.-Right weighed eighteen and three-quarter ounces; left

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H. W Grrdtan and E. W. Oochrane 531

thirteen and a' half ounces. Anterior margins of both were pale and emphysematous. Posteriorly, both were in a state of hypostatic congestion, which condition was more marked on the right side.

Heart.-Weight, eight and a quarter ounces. Pericardium, healthy. Large ante-mortem clot in right ventricle which obliterated more than half the cavity. Small ante-morte1n clot in left ventricle. Valves healthy.

Liver,-Weight, forty-eight and a half ounces. Surface, mottled and substance firm. Organ congested and full of blood.

Spleen.-Weight, four and a half ounces. Shrunken and contracted. Capsule furrowed in many directions, tough and much thickened. Had evidently been considerably enlarged at some period.

St01nach.-Normal. No inflammation, no ulceration. Intestines.-Abdominal contents normal in appearance, except

that the omentum was very much wasted and contained little fat. No pathological condition discovered in intestinal tract, except that about a dozen adult Ankylostoma duodena le were found adhering to the mucous membrane of the duodenum and jejunum. Mesenteric glands slightly enlarged.

Kidneys. -Right' weighed five and a half ounces; left, six ounces. Both markedly congested with adherent capsules.

Remarks.-The last date on which trypanosomes were seen in the blood was August 8th. They were numerous at 11.30 a.m. on that date. At 1.30 p.m. none were seen. The presence of a flagellate body in the stools is interesting. It is evident that the trypanosome was in the cerebro-spinal fluid when the case was first diagnosed. No filaria were seen in the patient's blood.

ANIMAL REACTIONS.-EFFECT OF THE INJECTION OF BLOOD FROM

PRIVATE MOMO YETO INTO GUINEA-PIGS AND WHITE RATS.

Two guinea-pigs and two white rats were inoculated with blood from the finger of Private Momo Yeto on July 10th, 1905, when patient was suffering from typical sleeping sickness.

Sub-inoculations were made, the animals employed being guinea-pigs, tame white rats and monkeys. The virulence of the trypanosome was not increased by sub-inoculation into guinea-pigs. In white rats the virulence was increased, the incubation period being shortened from seventy-three days to four and six days. The disease caused a progressive amBmia in these animals. Their pink eyes became a pale glassy tint. Their ears and feet became dead

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532 T'rypanosorniasis in the 'West .African Regirnent

white. They developed a watery conjunctivitis, which passed on into panophthalmitis in two cases. .

Rats Nos.' 4 and 5 were brought to England. The cold undoubtedly hastened the death of rat No. 4. The panophthalmitis may have been due to injury on the voyage home. Three rats were brought home in one cage, one infected with T. lewisi and the other two with T. gambiense. Both the T. gambiense rats developed panophthalmitis of one eye. The eyes of the other rat were unaffected. None of the rats or guinea-pigs developed any nervous symptoms. The monkeys had only been recently inoculated when I (H. W. G.) left Sierra Leone.

The temperatures of the guinea-pigs ranged between 1020 and 1040 F. The temperatures of the rats ranged between 100~ and 1020 F. (Seventy-nine observations on one rat.)

When inoculating animals, the blood was first received into a solution of sodium citrate and chloride 1 per cent. and 5 per cent., and the blood diluted many times.

The temperatures of the animals were taken by Corporal Simes, R.A.M.C.

Experiment I. Guinea-pig.-To note the effect of the injection of blood from Private Momo Yeto into Guinea-pig.

July 10th, 1905.-Examined guinea-pig's blood. No trypanosomes seen. Injected a few drops of blood from Private Momo Yeto's finger into peritoneum. The blood contained trypanosomes.

October 9th.-A corneal ulcer and pus in the anterior chamber of one eye noticed.

October 10th.-Died. Remarks.-The trypanosomes first appeared in the blood thirty

three days after inoculation. The animal did not show any outward signs of illness until a few days before its death. It took its food well, its coat was glossy and its eyes bright. A few days before death its coat lost its glossiness and the animal became very thin.

TABLE SHOWING PRESENCE OR ABSENCE OF TRYPANOSOMES IN THE BLOOD

OF GUINEA·PIG.

Date. Trypanosomes in blood. Weight in grammes. July 10, 1905 ..

" 15,

" 474

17, " 448

" 18,

" 434 20,

" No observation 445

" 31,

" 401

August 11, " + 465

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H. W. Grattan and E. W. Oochrane 533

Date. Trypanosomes in blood. Weight in grammes. August 13,1905 No observation 455

" 14,

" + "

15, " + 480

21, " + 465

22, " +

" 23, + 24,

" + 26,

" + "

28, " + 485

September 3, " +

" 10,

" + 14, " +

" 28,

" + October 3,

" + 340

" 6, " +

" 9, "

No observation 305

" 10, " +

Died.

Experiment n. Guinea-pig, ~ .-To note the effect of the injection of blood from Private Momo Yeto into Guinea-pig.

July 10th, 1905.-Injected about six drops of blood from the finger of Private Momo Yeto into the peritoneum. The blood from Momo Yeto contained trypanosomes, from three to four per cover.

August 14th, 1905.-Trypanosomes seen in the blood, thirty-six days after inoculation. . The guinea-pig appeared to be in perfect health until December 19th, when its coat began to lose its sleek appearance.

December 21st, 1905.-Found dead. It had given birth to two young ones during the night. They were both dead.

Post Mortem.-Placenta retained, but not adherent. Spleen small, measured 4 by 1'75 c.mm. Weight 2'15 grammes. The most noticeable feature was the large size of the liver; it weighed 21'6 grammes. The dead guinea-pig weighed 410 grammes.

TABLE SHOWING PRESENCE OR ABSENCE OF TRYPANOSOMES IN THE BLOOD OF

GUINEA· PIG.

Date. Trypanosomes in blood. \Veight in grammes. July 10, 1905

" 15, 465 17, "

" 18,

" "

30, "

No observation .. \ 425 August 10, "

" 14,

" + "

15, " + 18,

" No observation 518

" 21, 530

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534 Trypanosomiasis 1,11, the West A.frican Regiment

Date. Trypanosomes in blood. Weight in grammes. August 22, 1905

" 23,

" 26,

" 28,

" + "

29, "

No observation 505 September 2,

" + 6, " +

10, " +

15, " +

18, " +

20, " +

" 29,

" + October 3,

" + 6,

" + 11,

" + 12,

" + 16,

" + "

25, " + 559 (pregnant)

November 3, " +

6, " +

10, " +

14, " +

18, " +

" 24,

" + December 2,

" + 622'5 12,

" + 20,

" + 523'5

Experiment Ill. White Rat, d' .-To note the effect of the injection of blood from Private Momo Yeto into White Rat.

July 5th, 1905.-Examined blood for trypanosomes. Negative. July 10th, 1905.-Examined blood for trypanosomes. Negative.

Injected a few drops of blood from Private Momo Yeto's finger into rat's peritoneum.

September 20th, 1905. A trypanosome was seen in the blood for the first time. Incubation period, seventy-three days. The blood had not been examined since August 28th.

October 27th, 1905.-Rat keeps very quiet. October 31st, 1905.-Rat is anremic. The eyes are losing their

pink colour. A stained blood film shows many trypanosomes, chiefly the long form with many granules in their protoplasm. The red cells show polychromatophilia.

November 22nd, 1905.-Blood swarming with trypanosomes. Rat killed by chloroform.

Post Mortem.-Spleen enlarged, measured 7'5 by 1'25 c.mm.

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El. W. Grattan and B. T¥. Cochmne 535

TABLE SHOWING PRESENCE OR ABSENCE OF TRYPANOSOMES IN THE BLOOD OF VVHITE RAT.

Date. Trypano~omes in blood. July 5, 1905

10, 15, 17,

" 18, August 14,

15,

" 28, September 20, + October 3, " +

" ~ + n, + 1~ + 16, +

" 25, + November 22, " +

Rat killed by chloroform.

Experiment IV. White Rat, 'i' .-To note the effect of the 'injection of blood from Private Morno Yeto into White Rat.

July 5th, 1905.-Examined blood for trypanosomes. Negative. July 10th, 1905.-Injected a few drops of blood from finger of

Private Momo Yeto into peritoneum. December 4th, 1905.-This rat was looked upon as a failure.

At :3 p.ll. it was noticed to be dying from dyspnooa. Tail blood, venous. One cover showed one dying and one dead trypanosome. Polychromatophilia and nucleated red cells present. The rat died gasping for breath.

Post-mortern.-A few trypanosomes seen in stained specimen of heart's blood. The rat is fat and well nourished. No obstruction to air passages. Throat, larynx, trachea and bronchi examined. 'l'issues generally anmilllC. Lungs pale. Spleen measured 5' 5 by '75 c.mm.

TABLE SHOWING ABSENCE OR PRESENCE OF TRYPANOSOMES IN'THE BLOOD OF WHITE RAT.

40

Date. JUly 5, 1905

10, 15, 17,

" 18, August 14,

15,

" 28, S~ptember 20,

21,

" 22, October 3, December 4,

Trypanosomes in bloo(!.

+ Died.

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536 Trypanos01niasis in the West African Regiment

EXAMINATION OF THE WEST AFRICAN REGIMENT, FOR FURTHER

CASES OP SLEEPING SICKNESS.

When the case of Momo Yeto was reported we made an inspection of the regiment at headquarters ('Vilberforce). The inspection consisted of palpating the cervical glands, and it was not until November that the inspection of this regiment was completed, owing to a number of men being absent on furlough. We picked out nineteen men on account of enlargement of the cervical glands. Gland puncture- was performed in all. vYe found trypanosomes in the gland juice of three men, Privates • James Gaba, Makan Kamara, and Momodu. The first two men are employed as hospital messengers, so that they can be kept under constant observation and their treatment with arsenic and atoxyl carried out regularly.

No. 2573. James Gaba.-A Mendi from the town of Tikonko in the Bandyjuma District, Sierra Leone Protectorate. He lived there until 1900, when he came to Freetown and obtained employment as a carrier in the Ashantee War of 1900-01. He was about six months in Ashantee, and then returned to the Sierra Leone Protectorate, where he was employed as a Court Messenger for four years. He subsequently returned to Freetown and enlisted in the vVest African Regiment on April 14th, 1905. He is a tall, wellbuilt, muscular man, aged about 24. He says that he has never suffered from sickness of any kind, with the exception of slight enlargement of the cervical, inguinal and femoral glands; nothing '1bnormal can be detected by examination. Has no nervous symptoms, neither tremor of the lips, tongue nor hands, and his superficial and deep reflexes are normal. The glands are somewhat soft to the touch; there is no periadenitis.

August 26th, 1905.-Gland pnncture, left posterior cervical: eighteen active trypanosomes seen per cover. Two covers of blood

. examined; no trypanosomes seen. Auto-agglutination present. August 28th, 1905.-Blood count (H. W. G.): Red blood cor

puscles, 5,580,000; white blood corpuscles, 8,660; hffimoglobin, 82 per cent. (Gowers).

August 29th, 1905.-Stool examined. duodenale present. Gland puncture, right trypanosome seen.

Ova of Ankylostomu1n posterior cervical: one

August 31st, 1905.-Has been in hospital since August 26th, 1905. When admitted there was a small ulcer on the back; nothing of interest was seen in a stained film from this ulcer. He complains

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H. W. Gmtta,n (u~d E. W. Oochmne 537

of being kept in hospital. He feels perfectly well and is anxious to get back to his duty.

September 6th, 1905.-Weight in regimental clothing, without accoutrements, 12 st. 3 lbs.

October 20th, 1905.-Employed as hospital messenger. Temperature recorded twice daily_ Ordered 5~ grain arsenious acid by the mouth daily.' He walks every other day to Tower Hill and back (six miles).

November 2nd, 1905_-Administration of atoxyl commenced; t grain given hypodermically every other day. These injections caused no pain or inconvenience of any description.

November 30th, 1905.-The arsenic appears to have had a good effect on his temperature. Gland puncture, left cervical: several actively motile trypanosomes seen. The temperature has not been above 99° F_ for the last twelve days. Gland puncture, right and left femoral: no trypanosomes seen; the preparations of gland juice were bad ones.

December 4th, 1905.-BIood count (E. W. C.): Red blood corpuscles, 4,884,000; white blood corpuscles, 10,185 per c.mm.

December 19th, 1905.-Weight in regimental clothing, without accoutrements,l1 st. 101bs. One-fifth grain 'of atoxyl has been given hypodermically every other day since November 2nd, 1905.

Captain A. H. Morris, RA.M_C., informs us that Private J ames Gaba died from acute pneumonia in February last.

No. 2201. Private Makan Kamara.-Belongs to the Joliffe tribe which inhabits the French territory north of the Sierra Leone Protectorate_ His enlisted age is 26, but he is probably older. There is great difficulty in gauging accurately the age of recruits, as they themselves have no idea of time, and even if they understand the question when asked how old they are, probably reply "6 years" or something equally absurd. He enlisted on December 24th, 1902. He appears, from his own account, to have had an adventurous life up to this time, as he says he has fought against the French on three different occasions, and his reason for enlisting in the British Service was that the French had killed some of his relations. He was also a slave dealer in a small way, and says that he used to catch men belonging to unfriendly tribes and take them down to Conakry and sell them as slaves. He asserts that he has sold over twenty men as slaves, and by doing so "he done catch plenty copper." He is a man of fairly good physique, and is tall for a "Vest African. He has a general enlargement of the superficial

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538 Trypanosomiasis in tlte West Af?"ican Regiment

glands. His skin is dry and scaly; his gums are unhealthy, pyorrhooa being present.

Private Makan Kamara was in hospital from July 13th, 1905, to August 5th, 1905, for acute pneumonia. The highest temperature recorded during convalescence (July 24th to August 4th) was 98·8° F.

August 26th, 1905.-Gland puncture, right and left cervical: no trypanosomes seen.

August 29th, 1905.-Gland puncture, left femoral: one active . trypanosome seen. Two cover-slips, finger blood examined: no trypanosomes seen; auto-agglutination present.

October 29th, 1905.-Employed as hospital messenger. Temperature recorded twice daily. Ordered la grain arsenious acid daily.

November 2nd, 1904.-Administration of atoxyl commenced; t grain given hypodermic ally every other day. .

November 4th, 1905.-Blood count (E. W. C.): Red blood corpuscles, 4,800,000; white blood corpuscles, 1,100. Gland puncture, right cervical (H. ,V. G.): four active trypanosomes seen.

N oV6mber 6th, 1905.-vVeight, 10 st. in regimental clothing, without accoutrements.

December 18th, 1905.-Weight, 9 st. 12 lbs. in regimental clothing, without accoutrements.

Captain Morris writes that Private Makan Kamara died after a fortnight's illness, from" some form of colitis," in February last.

Momodu.-The fourth case, Private Momodu, was picked out on November 11th, 1905. On puncturing the left posterior cervical gland several active trypanosomes were seen. He is a recruit of a few months' service, and comes from the Bambara country, which is in French territory north of the Sierra Leone Protectorate. He is about 20 years of age, and is of poor physical development, though apparently healthy. There are no nervous symptoms, no tremors, &c. As far as can be made out he appears to have travelled about in French country as a carrier, and has been to Conakry several times. He talks very little English, and it is difficult to get information from him as to his past history, as, even with the assistance of an interpreter, his answers are rather unsatisfactory. He had visited Sierra Leone the year previous to enlistment, and he then returned to his own country and came back again and enlisted in July, 1905. He states that he has never been farther down the coast. He does not complain of anything.

The right femoral gland is much enlarged and measures 5·5 by

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H. fV. Orattan and E. 11fT. Oochmne 539

2'5 cm. The left femoral is also enlarged. The inguinal glands are distinct. There is a general enlargement of the glands along the posterior margin of the sterno-mastoid .. No glands can be felt in the axilla.'

"Ve palpated the cervical glands of 1,020 N.C.O.'s and men of the regiment. There was no marked difference in the gland incidence of companies. Of the four cases of trypanosomiasis all belonged to different companies.

John Try, No. 2590, was one of the cases of enlarged glands in which we failed to find trypanosomes. Gland puncture was performed eleven times. Gland juice from the right and left cervical, right and left femorals, left axillary and epitrochle!»r glands, was examined with a negative result.

On October 30th, a monkey, Cercopithecus cynosurllS (?), was illoculated with 10 cc. of blood from the median basilic vein, and a guinea-pig with 2 cc. On December 15th both animals were negative.

Priyu,te John Try had Filaria nocturna. On examining the blood at 10 p.m. from one to three filaria were seen per cover. An examination of nine thick covers at 3 p.m. showed only one filaria. No filaria were seen in the gland juice. Some of the preparations of gland juice were excellent and we fully expected to find active trypanosomes, but failed to do so. The phenomenon of autoagglutination was present in the blood. The man stated he felt quite well.

In another case a filaria was seen in the juice from a femoral gland. Examination of ten thick covers of blood by night showed no filaria.

Captain A. VV. Sampey, RA.1VLC., drew our attention to an entry in the admission and discharge book of the West African Regimental Hospital at Magbele. It was as follows:- .

"No. '033 Private Kabba Lambo, aged 24, transferred to headquarters for invaliding, April 8th, 1904; disease, sleeping sickness." vVe were unable to find any detailed history of this case. On arrival at headquarters his disease was changed to suppuration of lymphatic glands, April 15th, 1904. His disease was again changed to epilepsy on ,Tune 21st, 1904. He died on September 28th,1905.

One of us palpated the glands of 280 natives in the village of Yonnibannah, where Private Momo Yeto came from. None had typical enlargement of the cervical glands. These glands were

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540 'l'Typano8omiasis ,in the vVest Afrimn Regiment

palpable in thirteen cases. Both femoral glands were punctured in six of these cases. No trypanosomes were seen. Specimens of a small tsetse-fly caught in this village were forwarded to the Editor of the JOURNAL OF THE ROYAL ARMY MEDICAL CORPS. They proved to be Gloss'ina palpalis (Austen). We caught G. palpalis in the Hill Station about one mile from barracks.

Thoma Zeiss' apparatus was used for the blood counts. In estimating the number of red cells a minimum of 1,000 corpuscles was counted. We used both the red and white pipette for counting the leucocytes.

The measurements of three stained specimens of the trypanosomes from Private Momo Yeto's blood were as follows: 27 j.k by 2 j.k, 24 j.k by 2·3 j.k, and 17 j.k by 2 j.k. They were measured by a standardised eyepiece micrometer, and also by a Leitz' drawing camera. A scale is first projected, and drawn, a slide with a stained trypanosome is then substituted for the scale, and the image is thrown on the paper above the scale. Then with a piece of fine thread and a pair of forceps the trypanosome is measured.

For gland puncture we prefer the ordinary all-glass hypodermic syringe with a fine sharp needle. A blunt needle causes pain.

One of us is submitting a short paper on gland palpation and puncture, with especial reference to trypanosomiasis amongst the civil population of Sierra Leone. In it will be included some remarks on the distribution of G. palpalis.

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