NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
( 13 )
4th.—That it is confined to the bovine race, and is not communicable to other animals, nor
to man. (Mr. Floyd's account however would rather negative this, as he believes two horses
caught the disease and died of it.)
5th.—That although no specific has been discovered, yet that judicious and careful
treatment promises success. Such treatment consists in mild purgatives, combined with
aromatic stimulants, and diffiusible stimulants as ether, nutritious and stimulating drenches,
such as beer drenches, counter-irritants, free circulation of air, and scrupulous cleanliness.
6th.—That careful hygienic measures are of the greatest importance, such as wholesome
food, pure water, fresh air; removal from jungles, and other sources of malaria, and in case of
an invasion of the disease, complete and absolute separation of the healthy from the diseased
and suspected cattle, the immediate destruction of every article or substance that can hold
the infectious properties of the disease, and careful cleanliness of the premises occupied by
cattle and disinfectants scattered on the floors, &c.
We would lastly draw attention that, although the disease we have been treating
of, is one of the most fatal, it appears to be one the least generally recognized, amongst
the several Epizootics in India, to which diseases, the term Ghootee or Bussunt, or some other
name signifying Small-pox is given, yet that no true Variola or Small-pox really appears in
any of the descriptions. The very fatal Epizootic in which vesicular eruptions are observed,
is probably the Eczema Epizootica. Pleuro-pneumonia is doubtless common ; and the disease
which we have treated of is the " Rinderpest."
In India we were accustomed to the terms " cattle plague" and " cattle disease,"
when our attention was drawn to the subject in 1864, and our fears that the Epizootic
would become more formidable than it did, were aroused. We hear much now of " cattle
plague" and " cattle disease" in England ; no distinguishing name has been given it; it is
not even classified so far as we know, and we have therefore in the want of a better term
designated the disease we have treated of as the "Calcutta Epizootic of 1864."
C. PALMER, M.D.,
Presidency Surgeon.
[Exd. F. Pereira.]
SLEEPING SICKNESS
A SUMMARY OF THE WORK
DONE BY THE SLEEPING SICK-
NESS COMMISSION, 1908-1910
BY
CAPTAIN F. P. MACKIE, I.M.S.
Issued under the Authority of the Government of India by
the Director General, Indian Medical Service
CALCUTTA
SUPERINTENDENT GOVERNMENT PRINTING, INDIA
1912
Price Re. 1 or 1s. 6d.
SLEEPING SICKNESS
A SUMMARY OF THE WORK
DONE BY THE SLEEPING SICK-
NESS COMMISSION, 1908—1910
BY
CAPTAIN F. P. MACKIE, I.M.S.
Issued under the Authority of the Government of India by
the Director General, Indian Medical Service
CALCUTTA
SUPERINTENDENT GOVERNMENT PRINTING, INDIA
1912
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INTRODUCTORY REMARKS.
THIS brochure, which it is hoped will be useful both to
the
medical profession and the lay public in India,
gives, in popular language, a clear exposition of the present
state of our knowledge as regards Sleeping Sickness.
It is extremely improbable that this disease will ever
obtain a foothold in India, but, as Captain Mackie remarks,
it would be unwise to neglect precautionary measures.
Up to the present there is no record of the existence
of Tsetse flies in India, but it must be remembered that
they can live in other parts of the world besides Africa,
and there is no reason why. if once introduced into this
country, they should not spread and multiply. It is not
so very long ago that there were no rabbits in Australia.
Moreover, it is by no means certain that the Tsetse
flies are the only carriers of the parasite of Sleeping Sick-
ness.
The argument that in the old days of the slave trade
negroes stricken with. Sleeping Sickness were imported into
the New World without causing an epidemic of the disease
is beside the point. We must allow for the increased
facilities of communication which exist now-a-days, and
which render possible the importation into India, not only
of individuals and animals harbouring the parasite, bat also
of the insect carriers of the disease ; and we cannot afford
to take any risks in this respect.
C. P. LUKIS.
SIMLA ;
The 7th March 1912.
CONTENTS.
PAGE.
Introduction by the Honourable Surgeon-General Sir C. P. Lukis,
K.C.S.I., M.D., F.R.C.S., Director General, I.M.S. .
.
. Preface
Sleeping Sickness i n man .
.
.
.
.
3
The Trypanosoma Ganibiense
.
.
.
4
The description and habits of the tsetse fly .....
5
The question of other insect carriers
.
.
.
.
.
.
8
The development of the trypanosome in the tsetse
fly
.
.
11
The question of the mechanical transmission of Sleeping Sickness .
13
Further researches on the development of the trypanosome
.
.
14
The Reservoir of the Virus of Sleeping Sickness
.
.
.
.
18
Treatment of Sleeping Sickness .
.
.
.
.
.
.
26
The prevention of the disease
.
.
.
.
.
.
.
27
Can Sleeping Sickness get a foothold in India ?
.
29
Laws affecting the importation of the disease into India
.
.
30
Addendum
.
.
.
.
.
.
.
33
List of Publications by Sleeping Sickness Commission .
.
.
37
The Sleeping Sickness Commission of the Royal
Society, 1908-1910.
Constitution.
COLONEL SIR DAVID BRUCE, Κτ,, C.B., F.R.S., A.M.S.
CAPTAIN A. E. HAMERTON, D.S.O., R.A.M.C.
CAPTAIN H. R. BATEMAN, R.A.M.C.
CAPTAIN F. P. MACKIE, I.M.S.
LADY BRUCE, R.R.C.
The following is a short account of the present state of our
knowledge of Sleeping Sickness and has special reference to the work
of the above Commission. If in these pages any statements are
found which seem to differ from those made in the official publica-
tion of the Commission the responsibility for them is mine alone.
In the compilation of this report. I have had frequent resort
to the Bulletin of the Sleeping Sickness Bureau, to the Editor
of which I tender my thanks.
F. PERCIVAL MACKIE, M.B.,
F.E.C.S., M.E.O.P., CAPT., I.M.S.
SLEEPING SICKNESS.
Sleeping Sickness is a disease affecting man and is caused by a
blood parasite, the Trypanosoma, Gambiense (Dutton), which is
transmitted by the bite of a species of Tsetse fly known as Glossina
Palpalis (Rob-Dev). The disease is confined to the tropical and
subtropical regions of Africa, but it is slowly spreading along the
line of human communication.
Distribution.—The clinical symptoms of this disease were
recognised more than a century ago on the West Coast of Africa,
and about that time the disease made its way into the New World
amongst the negroes who were carried there from Africa as slaves.
In 1901 Forde and Dutton who were working in the Gambia
country found a trypanosome in the blood of a person suffering
R
2
SLEEPING -SICKNESS.
from fever and the parasite was called " Trypanosoma Gambiense "
and the disease " Trypanosome fever."
It was not till Castellani discovered the same parasite in the
blood of persons suffering from Sleeping Sickness in Uganda and
until the significance of his discovery was emphasised by Bruce
and Nabarro that the relationship between trypanosome fever
and Sleeping Sickness was fully recognised.
By the labours of Bruce and Nabarro and of Greig of the Indian
Medical Service and of Gray and the lamented Lieut. Tulloch of the
Royal Army Medical Corps, the true relationship of the Trypa-
ncsoma Gambiense to Sleeping Sickness was established and the
parasite was by these observers proved to be transmitted by a
species of tsetse fly.
Since then Sleeping Sickness has been found to be a much more
widespread disease than was formerly supposed. It appears to
have spread from West Africa throughout the basin of the Congo,
thence into Uganda where it has caused a terrible mortality.
Since then it has spread southwards into German East Africa
and into Nyassaland ; northwards into the Lad o enclave and into
the lower Soudan. Recently there have been alarming reports
that it is spreading southwards into Rhodesia so that altogether
the increased extent of its distribution is giving rise to grave
concern.
The problem concerned with the disease may be discussed
under four headings :—
I.—The disease in man.
II.—The parasite which causes it.
III.—The fly which carries the disease.
IV.—The reservoir of infection.
I.—THE DISEASE IN MAN.
The present Commission did not specially concern itself with this
aspect of the question, but for the sake of completeness a few
words must be said about the clinical symptoms.
SLEEPING SICKNESS.
3
I.—SYMPTOMS OF SLEEPING SICKNESS IN MAN,
The incubation period is somewhat uncertain but is probably
a matter of days or of a week or two at the most. We found that
the incubation period in monkeys was almost invariably under ten
days and nearly always either six or seven days.
The blood of the monkeys was infective two or three days
before trypanosomes were first seen in their blood by microscopic
examination.
The first stage of the disease is febrile and is generally put down
to malaria. The pyrexia is intermittent and is probably associated
with the recurrent appearance of the parasites in the blood. These
febrile attacks may recur for months or even for years without
involvement of the nervous system and the patient becomes
ansemic and debilitated.
Rashes occur during this stage and are either erythematous or
vesiculo-papular. Occasionally there are painful nodular swellings
or plaques from which the trypanosomes may be recovered. They
are apparently similar to those seen in horses suffering from
dourine, a disease due to Trypanosoma Equiperdum.
Pennato graphia, a form of skin affection generally ascribed
to vaso-motor disturbance, is not uncommon. These rashes, though
they may be of great help in diagnosing Sleeping Sickness in fair
skinned people, are difficult to recognise in dark skinned races.
A sign first described by Kerandal and known by his name is
that of deep hypersesthesia. When the soft parts, such as the
calves of the legs, are pinched or squeezed, acute pain is felt.
The sign resembles that commonly found in some forms of
neuritis and probably is due to a similar cause.
The most important diagnostic sign is the enlargement of
lymphatic glands, particularly those in the posterior triangles of
the neck. The glands are soft and elastic and remain discreet,
though they may become large enough to form an obvious swelling
in the neck. This diagnostic sign is the most easily recognised of
all signs and its value was greatly enhanced by the discovery made
B2
4
SLEEPING
SICKNESS.
by Captain Greig of the Indian Medical Service and Captain
A. C. H. Gray of the Koyal Axmy Medical Corps who found that
trypanosomes could readily be found by puncturing the glands in
a very large proportion of cases. (97·4 % Koch).
The characteristic signs of the earlier stages of Sleeping Sick-
ness are :—(1) Pyrexia (with or without trypanosomes in the blood
stream). (2) KerandaPs sign (deep hypersesthesia). (3) Certain
rashes. (4) Cervical buboes (containing Trypanosoma Gambiense.)
By means of these signs the disease can be recognised in quite
an early stage.
The second or cerebral stage (Fig. I & II) is the one which gives
to the disease the name of Sleeping Sickness. The earliest sign is
said to be a change in disposition and a loss of mental and moral
tone. The patient becomes dull and apathetic and often dirty in
his habits, showing at the same time a disinclination to work or to
exert himself at all and a tendency towards somnolence on being
left to himself.
Fine tremors occur in the fingers and extend to the limbs and
head ; incoordination and even Rombergs symptom is met with
and rigidity sets in in certain muscles.
Headache is common throughout the stage and occasionally
hypersesthesia or neuralgias. The Argyl-Robertson eye symptom
is stated not to occur and Babinsld's sign is absent.
The other vital organs are not generally affected, but as the dis-
ease progresses the patient becomes more and more somnolent and
eventually passes into a condition of coma in which he may linger
for days or weeks before death finally occurs. There are several
features in the above condition which will remind the clinician
of the late stages of general paralysis of the insane, and when one
remembers the similarity of the underlying his to-pathological con-
dition the resemblance of the two diseases is not surprising.
II.—THE PARASITE OF SLEEPING SICKNESS.
The Trypanosoma Gambiense is a protozoon belonging to the
class Mastigophora,
SLEEPING SICKNESS.
5
In length it is from 17-28 microns and in breadth about 2
microns. When observed in the blood of man or experimental
animals it does not vary much in size, but when undergoing
development in the interior of the tsetse fly very greab differences
in size and shape may be observed.
In structure it resembles other typical trypanosomes in possess-
ing a macro-nucleus situated medially, a micro-nucleus near the
posterior extremity and a well-defined undulating membrane which
commences at the posterior extremity in the neighbourhood of the
small nucleus and passing along the whole length of the body is
continued anteriorly as a free flagellum. Reference to the accom-
panying figure (Figs. Ill, VII & Vili) will make these points clear.
The Trypanosoma Gambienss is an obligatory parasite, being
only known to exist in the tissues of human beings suffering from
Sleeping Sickness, in the tissues of certain of the lower animals and
in infected tsetse flies.
Some observers claim to have grown it in cultures on Novy's
blood agar medium. Multiplication takes place by longitudinal
division, the process beginning in the region of the micro-nucleus
and extending forwards to result in the formation of two perfect
daughter cells. Sexual dimorphism is suspected but has not been
proved, and sexual conjugation has never been witnessed.
The changes which the parasite undergoes in the body of the
tsetse fly will be described later.
III.—THE FLY WHICH CARRIES THE DISEASE,
The tsetse fly Glossina Palpalis (Robinean-Desvoidy) is the
insect responsible for the transmission of Sleeping Sickness.
It belongs to the Genus Mv.sddæ of Dipterous insects and its
general characters are made clear from the accompanying figure.
(Fig. IV).
It is a dark insect about the size of a " blue bottle " fly and in-
habits a narrow belt of wooded country on the shores of certain
African lakes and the watercourses of rivers.
It is never found very Ear from water and is restricted to a
nacrow belt near to the water's edge and generally within a few
hundred yards.
6
SLEEPING SICKNESS.
It has a quick almost noiseless flight, and settles suddenly
on its victim, driving its long powerful proboscis deep into the skin
and filling itself with blood in about half a minute. The puncture
is generally quite painless but in some people is followed by mild
irritation and by a weal or lump.
The fly, which is thin and flat when empty, distends its abdomen
to the shape and size of a small red currant after a feed of blood
and then flies heavily away to digest its meal.
Although it is curiously local in its distribution it sometimes
travels on the bodies of men or animals or in canoes from one part of
the shore to another, and even may be found a mile or two in-
land when accompanying caravans.
When the local conditions are favourable the flies swarm in
large numbers and are exceedingly voracious, even biting Europeans
through thick clothes. The Glossina· are remarkable in that they
produce a single living larva at a birth instead of laying eggs as is
the manner of most flies.
The larva which is a small maggot like-creature wriggles actively,
and by this means burrows into the superficial layers of soft loamy
sand by the water's edge, and in a few minutes becomes darker and
motionless and becomes transformed into the pupa or chrysalis
stage. (Fig. IV.)
The perfect insect emerges after a time varying according to
the locality and climatic condition but probably in about six weeks.
Tsetse flies only bite in the day time and preferably in the heat of
the day.
The duration of their lives is certainly over 96 days, for the
Commission kept some in captivity for that length of time, so
that under favourable conditions in nature it is probably longer.
THE FOOD OF THE TSETSE FLY.
The natural food of Glossina Palpalis is a question which has
received a great deal of attention.
It is admitted on all hands that the tsetse fly is a pure blood
sucker and there is no evidence whatever to show that it ever lives
on vegetable juices. In its natural haunts near the water's edge
on the fringe of vast forests there is plenty of animal life available.
SLEEPING SICKNESS.
7
Professor Koch was of opinion that the chief source of its blood
supply was the crocodile, a statement which was misquoted to the
effect that he believed the crocodile to be the source of Sleeping
Sickness which he did not state.
It is true that the tsetse fly will suck the blood of the crocodile
just as it will that of almost any creature which contains blood, but
there are many places where tsetse flies are found where there
are no crocodiles.
In the large majority of the flies caught on the lake shore there
is no evidence of food of any sort ; this is doubtless because only
the hungry and therefore empty flies come out and are caught.
Thus out of a series of 220 tsetse flies brought to the Commission's
laboratory for dissection, only 27 per cent, contained the lemains
of blood, and out of this number the corpuscles in 9 per cent, were
recognised as being of mammalian origin and 4 per cent, non-mam-
malian. In the remainder the blood was too far digested to enable
one to recognise its origin. An experiment on a larger scale was
carried out, expressly to determine the point, and full details will be
found in paper No. 11 (vide Summary, page 37) from which the
following extracts are taken. " A journey was made to a small
" peninsula hereafter referred to as Crocodile Point."
" The place was distant about two and a half to three hours by
" canoe from the Kibanga landing place and lay in a sheltered bay
" far out of the beaten track of the canoes which came backwards
" and forwards between the islands of Kome, Damba and Buvuma
" and the weekly market at the Kibanga clearing.
" It was chosen therefore partly because if was isolated from
" human influences and also because of the large number of flies
"which lived there and the number of crocodile and birds which
" frequented it.
"When it was first visited a large crocodile was disturbed from
" where she was lying outstretched on a spit of sand. The canoe
" men at once set to work and unearthed fifty-eight crocodile's eggs
" lying in layers about eighteen inches below the surface over which
"the ' form ' of the parent was clearly defined in the soil.
" The peninsula was pointed in shape and not more than sixty
" yards long and was closed on the land side by the dense wall of
" forest which fringes the lake shore.
g
SLEEPING
SICKNESS.
" It was scattered with, light undergrowth and fringed by am-
" batch trees on which flocks of divers and cormorant sat with out-
" stretched wings drying in the sun.
" A barrier of bare rocks and boulders projected on one side into
" the water and a small school of hippopotami was generally to be
" seen floating near and basking in the sun.
" Many small crocodiles were disturbed from the undergrowth
" as the point was explored and various kinds of small land birds
" frequented the reeds and shrubs. The soil was sandy loam and
" shaded by light foliage. Tsetse flies swarmed.
" Subsequent to the experiment the daily catch of Lake shore
" flies was obtained from the place and incidentally it may be added
" that the flies caught here were found to be regularly infective to
" monkeys."
Pupse could be found in situation such as this by scraping the
superficial layers of the sandy loam. As many as two thousand
were found in a day by three trained pupa seekers.
A rough dissection of all the flies caught on the point was made
then and there, and those which contained the remains of a blood
meal were smeared on a slide and brought to the laboratory for
minute investigation.
The result of the examination of 183 flies caught at Crocodile
Point shows that nearly 60 per cent, of flies contained blood chiefly
of Β on-mammalian origin, of which reptilian blood was twice as
frequent as that of birds.
OTHER INSECT CARRIERS.
This is the place to discuss the very important question as to
whether Sleeping Sickness can be carried by any other medium
than by the tsetse fly.
Many experiments have been done to prove whether the Try-
panosoma Gambiense. can be transmitted by tsetse flies other
than Glossina Palpalis. The same has been attempted with bugs,
lice, mosquitos and other house parasites.
In a few instances some of these experiments have proved suc-
cessful, but in the majority they have been inconclusive and what
is more important Sleeping Sickness has never been known to be