If the patient cannot be removed from the infected district or cannot receive the atoxyl or atoxyl-tartar-emetic treatment the prognosis is almost surely that of a prolonged but fatal end.
There is very little hope of cure if the disease has gone on to the sleeping-sickness stage.
Prophylaxis and Treatment
Prophylaxis.—The question of depopulation of districts and destruction of the big game therein, when the area is infected with Glossina palpalis, has been fully considered under epidemiology.
Isolation, in the fly-free districts, of infected natives has not proven a very practical measure but that of rendering their peripheral blood free of trypanosomes by atoxyl injections would seem more desirable. In this we aim to cure the patient as well as render him safe to others.
The most practical measure is that employed in Uganda of clearing the plant and tree growth for at least fifteen feet from the streams of water, it having been noted that the tsetse flies confine themselves to a narrow strip not more than fifteen feet from the water’s edge. The tsetse fly requires considerable moisture for its existence.
The catching of flies in traps or with a sticky lime does not offer much encouragement.
As regards personal prophylaxis, white clothes are to be worn as the tsetse fly, along with mosquitoes, prefers dark-colored garments. The legs should be protected by leggings and possibly one could consider the wearing of gloves or veils. As a matter of fact, however, the heat of the tropics precludes these latter measures. As the fly only bites in the daytime one should choose the night for going about, if practicable.
Treatment.—The general opinion is that trypanosomiasis is only curable at a time prior to the appearance of trypanosomes in the cerebro-spinal fluid. Consequently, the stage of sleeping sickness offers little chance of cure by treatment.
Such cases have been treated with injections of 10 cc. of 1 to 1000 solution of neosalvarsan into the spinal canal, after withdrawing about 15 cc. of spinal fluid, but without appreciable curative effect. On the assumption that trypanosomes invading the central nervous system are protected from drug action, Marshall proposed the injection of salvarsanized serum intrathecally. Three hours after the administration of 0.6 gm. of salvarsan enough blood is withdrawn from a vein to give about 20 cc. of serum. Following the withdrawal of a slightly greater amount of cerebro-spinal fluid from 5 to 20 cc. of the serum is injected in its place. Yorke in a critical article on the claims for this treatment is of the opinion that there is no satisfactory evidence that such a method sterilizes the infected cerebro-spinal fluid. He cites cases where the trypanosomes disappeared from the spinal fluid after ordinary treatment and where cases lived for extended periods after trypanosomes were found in their spinal fluid. Corbus and associates have described a new method of obtaining a high medicinal content in the cerebro-spinal fluids. Their work was done with neo-arsphenamine, but there seems to be no reason why other drugs may not be similarly administered.