1. Sleep-sickness is sadly only too well known at Lukolela. It is prevalent in the whole of the riverine and inland districts. In the inland districts I am not yet able to say whether it is more prevalent than in the riverine one; that can only be ascertained by a more prolonged residence there than as yet I have had opportunity to make. In the riverine district I estimate that quite half of the deaths are from sleep-sickness. The cases do not occur in batches like cases of small-pox and measles do; there are too many in a given place unaffected at one time. It will, however, gradually sweep away whole families. The common notion among the natives is that the sickness came from down-river; and it was prevalent, though not to such an extent as now, as far back as the oldest people I have met can remember. Before our Mission was founded here a suspected case would be thrown into the river; but inland I do not think there is any evidence to show that they did otherwise than to-day—nurse their sick perfectly, heedless of the contagion in respect of them (the nurses) or their friends, and, as they do on the beach, bury their dead close to their houses, and in some cases live on the top of the graves.
2. From my own observation (since January 1891) the sickness is endemic; in the riverine villages the death-rate slowly increased until 1894, when the people quite lost heart and felt their homes were no longer secure to them, and then hunger, improper food, fear, and homelessness appeared to increase the death-rate from sleep-sickness and other causes most appallingly, and the rate has still further increased, especially during the last two years. The fewer the population becomes the proportionate rate of death increases most fearfully.
3. The district of Lukolela may be described as follows: The beach line is wooded, broken by one or two creeks, one of which winds for a considerable distance inland to a district which can be reached overland by a journey of at least three days at the shortest. There is more or less of low-lying land connected with the creeks. The 6 miles below the Mission station is lower than the 8 miles above. The highest point of our land is about 19 metres above high-water level, and possibly there is a further rise of 3 metres or so further up stream. The ground which I suggest the people be removed to may be on an average about 12 to 15 metres above high-water level. This ridge of river bank shelves down into low-wooded land and grass plains which are flooded at high water, though for the most part dry at the lowest ebb; then behind these rise small plateaus separated by low valleys of wooded and grassy land. From the pools and streams of this low ground the people get most of their fish; even when the river is at medium height a journey between the various plateaus where the villages and farms are found requires about half the time to be spent in wading, sometimes breast deep.
4. A large proportion of the population is comprised of slaves, mostly from the tributaries of the Equator district, some from the Mobsi, Likuba, and Likwala peoples on the north bank, some from Ngombe below Irebu, some from as far as the district of Lake Léopold II and other places. All the tribes represented seem equally affected, and neither slave nor freeman seems to have preferential treatment.
5. To an ordinary observer the men, women, and children appear to be affected alike. It is not easy to always differentiate the sickness from other maladies, for often it may be that the malady gives rise to various complications; these complications are extremely intractable if sleep-sickness be present. When a man in the prime of life has his prestige and spirit broken through fear and punishment he loses interest in his home, refuses to take food and drink; a sleep-sickness patient will do the same. With the women in all cases we have known there is also present amenorrhœa; sometimes treatment for this has restored the patient in this respect for a time, but there has in all cases we have known of this sort been a relapse; so whether the patient died of one or the other would be difficult to say.
6. The well-fed do not seem to fall before the scourge so rapidly as the ill-fed. The progress of the disease seems to us considerably slower as a rule with those who take care of their food and habits, but it attacks even the most scrupulously attentive to these matters.
There is a very bad practice amongst them: they will go sometimes days without eating, although they may have manioc and plantain, and other foods from the soil at hand, simply because they have no fish or flesh to eat with them; sometimes they pinch themselves in food to retain their brass rods for the purchase of some coveted article. The natives to-day are not so careful in the preparation of food, and it is more hastily performed; the manioc is eaten as nearly the raw state as they dare use it. The bitter manioc is mostly grown, as the yield from it is greater than from any other kind. Plantains are largely eaten roasted, and boiled, and beaten into a pudding. Palm-nuts, too, they are very fond of, and the oil forms a good part of the cooked foods. They use, especially in the absence of fish or flesh, the leaves of the manioc, which are bruised and boiled; in nearly every case, however, head-and stomach-ache follow, which pass off in a few days if bowels be active. Well-peppered food they enjoy, and rotten fish and flesh they do not, as a rule, despise. Their dried fish, of which a large quantity is eaten, is not by any means always free from maggots. Elephant meat seems to give them diarrhœa; dog-headed bats similarly; hippo meat generally produces slight constipation. I am afraid a good deal of disease is passed from person to person in the preparation of food. There is a great deal of eating together and drinking together from one and the same vessel; they dip their hands in the mess prepared as they sit round the pot, and I cannot say that they are too careful of the condition of their hands at the time. Clothing is usually scant except for decoration; hence the colder the weather the less the clothing, the brighter and warmer the more they carry. Washing is not a very frequent exercise among the natives. They like, as a rule, teeth kept clean, washing them every day and after every meal. They like to smear their bodies with oil and camwood. The hair is left undressed or dressed as the case may be for weeks at a time without further cleansing. Sleeping is mostly done on raised constructions of sticks, varying from half a-foot from the ground to about 3 feet or so. I am afraid that not much in the way of covering is used while sleeping, a blanket being mostly worn during the day as an article of fine clothing. Many, especially those in temporary residence, sleep on the ground floor with only a mat intervening. Jiggers, bugs, mosquitos, and vermin abound in their houses on the beach, but jiggers are not so plentiful, and mosquitos very rare inland. The inland people take great care of their water sources, but on the beach the river water is largely used, and this is of a dark brown colour; some is taken from the creeks, but it is very impure, abounding with decayed vegetation and clay, and some from springs, such as they are, and these are only surface drainings over the clayey subsoil. The sweepings of their huts and refuse from their food is not thrown far away, sometimes even being quite close up against one of the walls of the hut. In the daytime they relieve themselves in the nearest sheltered spot without further discrimination, and these places, in the present uncleared character of their surroundings, are very close at hand; in the night time they are not so particular, but will even relieve themselves in the open, and on the paths trod by every one. The common belief is that the disease is communicated by means of the secretions, and yet, strange to say, the natives take scarcely any precautions.
7. All the cases we have known have been fatal. We have thought sometimes we have done good with iodide of potassium and cod-liver oil, but if it did any good at all it was only very temporary. We judge from our observations that from the first symptoms which appear to be mental ones, the best cared for cases last for from one to three years. Others in which food is soon refused and neglect is suffered may speedily terminate in a few months, or even weeks, from the first certain indications. The first symptoms seem to be mental, the balance of thought fails at intervals, then come the physical signs of pain in the lower part of the back; often thought here to be piles, and they seek the usual remedies for this; later the pain extends to the whole back and then to the head, especially at the back of the neck, and drowsiness steals over the patient at inconvenient times, often the eyes become staring, the face assumes a haggard appearance, and anæmia casts its pallor over the whole body; intelligence rapidly diminishes, and often the patient dies foaming at the mouth; if burial does not take place quickly maggots soon make their appearance in the body. When the natives begin to stuff their remedies up their patient’s nostrils to take away the “confusion of eyes” (a phrase which they use to describe a person going out of his senses) the patient will very likely become violently deranged, and then he has to be forcibly restrained in stocks or otherwise.
Isolation is undoubtedly the first thing to do, but when to begin the isolation is a difficulty, and when that is settled to maintain the isolation is still a greater one. The patients could not be left to die, they would need food, attending to (for they become so helpless latterly) and burying, and almost all who undertook that work would be sure eventually to succumb. To get a person here, however, to look after somebody else’s relative is a well nigh impossibility by moral suasion.
I should have noted above that the experiment of better houses, such as the youths and workmen have built in the little village adjoining the Mission station (wattle and daub, with good high roofs), have given no benefit whatever. Very few of them will be able to remain for more than one or two years; the occupants are showing signs that are ominous; we shall need to burn them down at the decease of the occupants.