BEVIEW — TBOPICAL MEDICINE, ETC. 173 



maintained by the continued irritation of excessive perspiration. The disease is limited to Skin 

 those parts of the skin containing sebaceous follicles. His treatment consists in oily Diseases- 

 applications to the body-surface and the wearing of cotton next the skin. continued 



Wellmani has described a severe chronic pemphigoid disease of West Africa associated 

 with the presence of a diplococcus, and Clegg and Wherry,- dealing with the etiology of 

 pemphigus contagiosus in the Tropics, summarise their findings and conclusions as follows : — 



1. Prom cases of Pemphiijus neonatorum and one case of Pemphigus contagiosus in an adult, micrococci 

 similar to those described by Almquist were isolated. 



2. Although occurring as well-defined kidney-shaped diplococci in the contents of the vesicles, the organism 

 may, on superficial examination of cultures, be confounded with Staphyfococcun pyogenes aureus. Our cultures did 

 not produce indol in broth, and the diplococcus arrangement was reproduced in miUc, or, better, in serum broth 

 cultures. 



3. A single human inoculation experiment with this organism produced typical but abortive vesicles. The 

 essentially superficial nature of the inflammatory process set up in the human skin — resulting in the exudation of 

 serum and leucocytes, and the formation of vesicles and the absence of any tendency to penetrate into the deeper 

 tissues — certainly differentiate this micrococcus from the ordinary pyogenic cocci. 



4. We believe it advisable to call the disease Pemphigus contagiosus, whether occurring in children or adults, 

 and the etiological factor would then best be termed Micrococcus j'cmphigi contagiosa. 



5. Cases of typical Impetigo contagiosa should be examined along similar lines, as the disease described 

 under this name is possibly due to the same micro-organism. 



Sleeping Sickness. Considering, in the first place, methods of spread, one finds 

 that in the latest report'^ of the Liverpool expedition to Ehodesia, mention is made of 

 work in Uganda, where successful transmission experiments were made with Glossi7ia fusca. 

 It is possible also that G. morsitans, G. pallidipes and G. longipalpis are also implicated, 

 though in this connection one would quote Neave,* who in Northern Ehodesia found a 

 place which had become infected both as regards G. palpalis and man from a locality 150 

 to 200 miles distant. Tracing the route of caravans back to this locality, he found the 

 intervening country infested with G. morsitans but no G. palpalis and no sleeping sickness 

 existed. Hence he thinks G. morsitans should be considered not guilty until the contrary 

 is proved. 



At present it would appear that not only tsetses but all biting-flies must be considered 

 as possible carriers. Thus in the French Congo, Martin, Leboeuf and Eubaud^ have noted 

 how young children are often affected, and think that certain " domestic " insects, such 

 as mosquitoes of the genera Steejomijia and Mansonia, may be to blame. This, however, 

 requires confirmation. In Ehodesia all the work goes to show that the transmission is 

 mechanical. 



Koch," as a result of work in Uganda and German East Africa, is of opinion that 

 though it may be possible to infect G. fusca and G. pallidipes with the trypanosome, this 

 must occur so rarely under natural conditions that they may be disregarded as conveyers 

 of the trypanosomes. The same may be said of G. morsitans, which, he thinks, attacks 

 man very exceptionally. This is contrary to the experience of most observers, and certainly, 

 in the Bahr-El-Ghazal, 0. morsitans is a pest to man and animals alike. 



Koch also notes that though dogs and monkeys are known to have become naturally 

 infected, the occurrence is so rare and the animals have died so quickly after infection 

 that practically they may be disregarded as reservoirs of the disease. 



He has further drawn attention to the probability of the disease being communicated 

 by coitus. Thus, of 26 women in the German segregation camp, where there was a total 

 of 425 cases, 7 had never been in sleeping sickness regions. It would seem that they 



> Wellman, F. C. (August 1st, 1907), " Description of a Diplococcus found in the lesions of a severe, chronic 

 pemphigoid Disease in We,st Africa." journal of Tropical Medicine and Hygiene, Vol. X. 



' Clegg, M. E., and Wherry, W. B. (Slarch 2nd, 1906), " The Etiology of Pemphigus Contagiosus in the 

 Tropics." Journal of Infectious Diseases, Vol. III. Chicago. 



= Reviewed in Lancet, April 11th, 1908, p. 1110, Vol. I. 1908. 



■• Neave, S. (April 2oth, 1908), "Distribution of Glossina." British Medical Journal, Vol. I. 1908. 



' Martin, Q., Leboeuf and Rubaud (March 11th, 1908), "EpidiSmies de maladie du sommeil au Congo 

 Fran9ai3." Bull. Soc. Path. EmI., Vol. I. 



» Koch, R. (November 14th, 1907). Dextt. Med. IVoch., p. 1889. Quoted in Lancet, 30th November, 1907 

 p. 1578. 



Journal of the Royal Institute of Public Health, December, 1907, p. 751. 



Journal of Tropical Medicine and Hygiene, February 15th, 1908, p. 68. 



