KEVIEW — TEOPICAL MEDICINE, ETC. 175 



Another point that has attracted my attention in connection with these cases is the frequency (four in the Sleeping 



eight cases in which the point was inquired into) with which the symptoms were immediately ante-dated by what Sickness— 

 was described as a bite on the leg. The biting animal may have been a Glossiiia, but in the case of females — and conti'iued 



two of the bitten ones were females— one would suppose that the petticoat would afford a protection even more "' ' 



effective than the trouser does in men. 



Too much weight must not be attached to what may have been mere coincidence ; but these facts are curious, 

 and suggest further inquiry as to the possibility of some blood-sucker, perhaps some species of house vermin, being 

 -in occasional vector of Ti'i/paiiosoma gaiiibit'n.-yr. 



Next, as regards the disease itself and the parasite which presumably causes it, we find 

 Martin and Darre' describing certain nervous symptoms observable at the onset of the 

 malady. In one exceptional case, there was a general cutaneous hyperaesthesia save on the 

 plantar and dorsal surface of the feet where anesthesia was marked. There was also a 

 partial paralysis of the extensors of the great toe. Babinski's sign was present. The 

 symptoms slowly disappeared under treatment with atoxyl. The authors note that pains in 

 the feet often constitute one of the first symptoms and that they are always very persistent. 

 They lay great stress on this intense hyperaesthesia, which they say permits of an early 

 diagnosis being made and treatment being commenced at once, when ultimate cure is more 

 probable. They append a note by Kerandel on this symptom, whicli appears during the 

 second mouth of the illness and becomes marked during the third month. The slightest 

 contact with any hard object gives rise to acute pain, so that great care is exercised by the 

 unfortunate patient in sitting or lying down, taking hold of objects, passing through a 

 doorway, etc. The legs, the fore-arms and the hands are the parts most often affected. 

 The pain is sometimes sufficiently severe to make the patient cry out. Although severe, it 

 is very fleeting, passing off' in from two to five minutes, and it disappears in a few days 

 under atoxyl treatment. This hypersesthetic condition is said to be pathognomonic, and it is 

 suggested that it should be termed " signe de Kerandel." 



-"oo^ 



Attention has recently been directed to the craving for meat displayed by sleeping 

 sickness patients, and Mr. Archibald informs me that along with this a great desire for 

 salt was evinced by patients in the Ugandese camps. 



Moore aud Breinl- have a very important paper on the morphology and life-cycle of 

 T. gavibiense which is likely to provoke much discussion. They quote Dutton, Todd and 

 Hannington, who, dealing with the observations of Bruce and others in Uganda as to flies 

 being non-infective after forty-eight hours, stated : — 



We believe either (1) that something is wrong in the way in which Olossina palpalia has been used 

 in these experiments ; or, (2) that Trypanosome gambiense can be conveyed by some other means than by it. 



Moore and Breinl say : — 



So far, then, from its being established that sleeping sickness is normally spread among the African 

 population by the bites of Gtossina palpalia alone, it would seem that the most recent work on this subject 

 indicates that possibly the infection through flies is iu the nature of an accident, and that the means by 

 which sleeping sickness spreads, in the manner iu which it does spread in the African interior, has yet to be 

 discovered. 



They proceed to show that T. gamhiense varies very much in size in the same blood, 

 but they are unable to subscribe to the opinion that there are male, female and indifferent 

 forms. 



By special staining methods they demonstrate structures not hitherto described, such as 

 an intra-nuclear centrosome, as distinct from the extra-nuclear centrosome or blepharoplast. 

 There may, indeed, be several of the latter. They deal with the mode of multiplication 

 of T. gambiense in the blood, aud especially with the changes in the trypanosomes relative 

 to the stage of infection. They observed a curve of infection, the number of parasites 

 increasing and diminishing in the blood, and direct attention to the formation of what they 

 call " latent bodies," found in the lungs, bone marrow and spleen. Tliese latent bodies 

 eventually become transformed into small trypanosomes, but apparently only a certain 

 proportion of them undergo this change, the others disappearing. This indicates a complete 

 cycle in the blood of a single host, the rat being the animal studied. 



In rats the latent forms pass gradually into trypanosomes, these in turn divide through many generations, 

 and their multiplication is followed by a metamorphosis which, whether we regard it as a special form of 

 sexual process, as a form of pathogenesis, or as a sexual stage, the fuller details of which have not yet been 



' Martin, L., and Darre (January 22nd, 1908), " Sur les symptomes nerveux au debut de la Maladie au 

 sommeil." Bull. Soc. Path. Exot., Vol. I. 



2 Salvin-Moore, J. E., and Breinl, A. (November 9th, 1907), "The Cytology of the Trypanosomes." Annals 

 of Tropical Medicine and Parnsitology, Series T.M., Vol, I., No. 3. 



