TRYPANOSOMIASIS IN THE ANGLO-EGYPTIAN SUDAN 



117 



Pliiiimer aud Bradford* iu bonu-marrow in cases of nagana, and by Castellanif as 

 occurring in the cerebro-spinal fluid, in sleeping sickness. They were few in number and 

 stained feebly. A somewhat pear-shaped, flagellated form was the most striking. 



The second ox also died at a distance. In smears made from its blood trypanosomes 

 were fairly numerous. The stomach, which had been placed in spirit, was the only organ 

 brought to the laboratories. Attached to it was a small piece of omentum. On opening the 

 stomach a very curious condition of pigmented ulceration was disclosed, affecting the mucous Gastnc 



. --iii-i, ulceration 



membrane (Fig. 64). Scattered about were dark areas with thickened edges raised above 

 the surrounding mucous membrane. The surfaces of these areas were flat and slightly 

 depressed, and consisted of what was afterwards found to be altered blood clot. No smears 

 ■were made from these areas, but sections were cut and examined. Beyond a severe bacillary 

 invasion aud the appearance of considerable erosion and destruction of the mucous membrane, 

 nothing was found. 



The following are my notes on the condition : — 



"Exatnination of Ahomasnin nr Fourth tStomach — Cardiac end. — Nothing noticeable 

 externally. In a small piece of attached omentum there are two enlarged glands about the 

 size of peas, rounded, elastic to the touch, purple in colour externally, and deep purple on 

 section. The mucous membrane is of a uniform dark slate colour, no eccliymoses are present, 

 but there are some dark patches, possibly due to post-mortem changes. Studded over the 

 surface of the mucous membrane are spots of intensely black pigment (Fig. 64). Each 

 of these, in most instances, seems to surround a tiny punched-out-hole, and the pigmentation 

 is most marked in the central depression. A few black granules can, as a rule, be squeezed 

 out from the central pits. These granules were found to consist of altered blood. Where 

 the patches are more advanced, they present the appearance of ulcerations. Most of 

 these are more or less circular and depressed, but some are in the form of ulcerated streaks, 

 and all are intensely black. In addition there are a few patches of superficial pigmentation 

 in which there is no ulcerative process. 



Central 2>ortion. — -The condition is very similar, but the patches are larger, some of the 

 ulcerated " streaks " being f inch in length. In one or two places the ulcerations appear to 

 have healed, leaving depressed and whitish scars surrounded by areas of slight pigmentation. 



Pyloric end. — Nothing noted externally. The mucous membrane shows a general 

 pigmentation of the surface in the form of little circular shallow pits with pigmented 

 walls, the pigmentation being very slight. In addition, pigmented ulcers, similar to those 

 previously described, are present in considerable numbers, and in some instances a regular 

 plug of the black material fills up tlie ulcer and rises above the surface of the mucous 

 membrane. There are also present the superficial pigmentations already mentioned, some of 

 which are associated with slight erosion. Where the ulcers are marked, their edges are 

 thickened. The ulcerative process and the pigmentation are confined to the mucous layer. 

 In no instance does perforation seem to have occurred. Size of largest ulcer, f inch by 

 I inch." 



At the time I did not think that these ulcerations, which rather recalled the lesions 

 produced by the swallowing of a corrosive poison, were in any way connected with the 

 trypanosomiasis. Since then I have had reason to alter that opinion, as will be seen when we 

 consider the experimental work with the trypanosomes of mules. Captain Greig, whom I 



* Brit. Med. .Jouru., Loudou, Vol. I., 1903, Juue 20th. 

 t Journ. Tropical Medicine, Vol. V., 1903, p. 167. 



