| Abstract
| - Abstract. 1. 1. The results are described of an individual survey in Sierra Leone of over 2,000 sleeping sickness patients who had been treated by various courses of drugs more than a year previously; 1,800 of the patients were seen and examined and in nearly 1,000 of them examination of the cerebrospinal fluid was carried out. 2. 2. Criteria of final cure are discussed, and it is shown that a decision in individual cases cannot be arrived at with certainty within about 15 months after treatment. The only criteria accepted in this survey are (1) reliable information regarding mortality, and (2) the observed C.S.F. findings more than a year after treatment. Patients rendered blind by treatment were reckoned as failures. 3. 3. The C.S.F. cell count is shown to be a more sensitive indication of failure in Sierra Leone than total protein estimation. In a minority of cases the cell count is found to remain slightly raised up to 3 or 4 years after treatment even though there is every indication that cure has been complete. For this reason a figure of 10 cells has been accepted as the limit of normality in assessing the cure rate, but, to satisfy the most stringent standards, the percentages of cases with final counts below and above 5 have been furnished in addition. 4. 4. Since late cases are harder to cure than early ones, and since the proportion of late cases differed among the groups of patients treated by different drugs, the final results have been corrected to show the expected cure rate after each course in a collection of cases with standard C.S.F. cell distribution before treatment. The best combination of antrypol and tryparsamide is shown to yield a corrected final cure rate of 93·5 per cent. 5. 5. An incidental finding has been the prolonged protection against overt reinfection conferred by antrypol and probably also by pentamidine. 6. 6. In a small scale trial with a course which combined pentamidine and tryparsamide given concurrently in full dosage and was complete in 3 weeks, results were very promising, though the average Sierra Leone patient reacts so well to tryparsamide alone that it was impossible to prove the superiority of the combination. The risk of toxic sequelae and visual impairment with this combination appears to be very slight, and it is recommended for more extended trial in other parts of West Africa where the average case is more refractory to treatment with tryparsamide.
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