A clinical lecture on the sleeping sickness / by Patrick Manson.

Manson, Patrick, Sir, 1844-1922.

Date:: 1898

Catalogue details

Licence: Public Domain Mark

Credit: A clinical lecture on the sleeping sickness / by Patrick Manson. Source: Wellcome Collection.

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hospital. He was quite able to walk upstairs to Alexandra Ward. On admission under Dr. Abercrombie he seemed to be in good general health. He was fairly well nourished, and even sleek. Lately, however, he has fallen off somewhat in condition, and his hair and skin have become dry and lustreless. At first his breath was offensive ; this has now improved. His appetite and digestion are vigorous. The bowels on admission were constipated — as, indeed, they still are. Microscopic examination showed fchat the stools contained large numbers of the ova of ascaris lumbri- coides, of ankylostoma duodenale, and a few of t’richo- cephalus dispar. The thoracic and abdominal viscera appeared to be healthy. There was no sugar or albumen in the urine. Temperature has ranged from 97° to 99° F., being usually slightly subnormal. Pulse 80 to 90, respirations 20. The blood count gave 5,300,000 per cmm., haemoglobin 60 per cent. The blood contained no malarial parasites, but filaria perstans was, and is, present in moderate abundance —about 1 filaria in every cmm. The senses were, or appeared to be, normally active. Mr. Treacher Collins, who was good enough to make an ophthal¬ moscopic examination, found fundus and media per¬ fectly healthy. The pupils were equal and reacted briskly both to light and accommodation. A very few and ill-defined papules could be made out on the skin of the chest and abdomen, but there was no pos¬ tulation and no marked pruritus. The knee-jerks and other deep and superficial reflexes were active ; but his gait was shuffling and feeble, and his hand grasp was markedly impaired. When he walked he progressed slowly, his knees slightly bent. He was easily fatigued, and always seemed glad to sit or lie down. There was no muscular tremor, no local anaes¬ thesia, no paresis. The lymphatic glands, particu¬ larly those of the neck, were slightly but distinctly enlarged. In size they varied from an almond to a hazel nut ; they were not at all tender. Since admission his condition has varied very little. For the most part he keeps his bed, lying perfectly still with eyes shut, as if asleep. His face has an expression of deep melancholy, At times he sits up by the fire, but even then he seems to be asleep. The only time he rouses himself thoroughly is when food is brought, or when for a short time he goes on the balcony and watches the traffic in the streets. As a rule he is glad to get back to bed. A touch or a loud sound causes him to open his eyes, so that if he is asleep, the sleep must be a very light one. When spoken to he opens his eyes and answers questions slowly, in few words, and to the point. Even while he is being spoken to, often his eyelids fall as if he were overpowered by an irresistible desire to go to sleep. He never seeks to enter on, or to prolong, a conversation. He rarely smiles ; if asked, he says he is very unhappy on account of his drowsi¬ ness. Since he entered the hospital he has become distinctly more lethargic, and, I think, has lost flesh and muscular power. Case II.—Tendo Mkaloo, supposed to be about 11 years of age, comes from the same village, Mbanza Manteka, as Mboko. Very little is known about his antecedents. He is believed to have shown symptoms of sleeping sickness for about two months, that is to say, since May or June, before he left the Congo. During the voyage home he became much worse. When brought to hospital he was in a state of great emaciation and weakness. He could not walk with¬ out support, and was barely able to stand alone; he had to be carried upstairs. His cheeks were sunken, his eyes unusually prominent, his lips were swollen and dry, the saliva dribbling constantly from the corner of his mouth; his hair was dry and scurfy, and his skin harsh and lustreless. Arms, abdomen, and chest were streaked with white lines, nail marks from the scratching provoked by an incessant pruritus associated with numerous scaly papules. The superficial lymphatic glands and even trunks were universally enlarged, particularly so those on the back and sides of the neck. Some of the glands appeared to be very tender, for he carried his head stiffly as if movement hurt him, and he shrank and cried when an attempt was made to examine the little swellings distinctly visible at the side of the neck. His breath was foul, and his abdomen tumid and lax. The spleen was much enlarged, extending as far as the umbilicus ; the liver also was enlarged, its lower border being readily felt about a hand’s breadth below the costal margin. As in the case of his companion, his faeces contained myriads of ova of ascaris lumbricoides, ankylostoma duodenale, and trichocephalus dispar, and he was markedly constipated. His temperature was considerably above normal for some days after admission. Eyes, lungs, heart, and kidneys appeared to be healthy. The superficial and deep reflexes were active. He slept and drowsed almost continuously during the first few days. At first he had to be coaxed to eat, and had often to be fed by the nurse. Sometimes he would fall asleep at his. meals. There was some suspicion of muscular tremor. His blood count gave 4,500,000 per cmm., and a haemoglobin value of ,50 per cent. Filaria perstans was found in considerable abundance—8 per 5 cmm. No malarial parasites were discovered. After due preparation he had a course of thymol (15 grains for four doses at intervals of an hour and a half); this effectually rid him of his intestinal para¬ sites. Probably partly in consequence of this, partly in consequence of the warmth and good feeding, and partly in consequence of the large doses of arsenic he was put upon, his general health quickly under¬ went a marked improvement, and his spleen and liver diminished in size. Concurrently with this his drowsiness got less, and he is now much more lively; he even laughs occasionally. He sits up in bed or by the fireside and watches what is going on about him. He is also putting on flesh, and is able to walk about a little, though his gait is slow and shuffling. The pruritus, however, is as bad as, or even worse than, ever. His lymphatics, though diminished in size and no longer painful, are still distinctly enlarged. The prominence of the eyes is less marked ; he no longer dribbles from his mouth, and he feeds himself and eats with some appetite. He has had one or two feverish turns, but, as a rule, his temperature is normal or subnormal.