176 REVIEW — TROPICAL MEDICINE, ETC. 



Sleeping elucidated, seems undoubtedly to stand in one of these relationships to the normal cell multiplications preceding 



Sickness ^^^ formation of latent bodies. The stage in question results in the production of the latent bodies once more, 



coHlinued ^""^ *1^« cy'l^ '^ complete. 



It may be objected to this conception that, notwithstanding the cyclic development of Trypanosoma 

 gambiense, siiU there may exist a possibility, or probability, of the transference of the trypanosomes into some 

 other host where a further metamorphosis, representing the sexual stage of the organisms, is passed through. 

 This, of course, may bo so, but we have in the case of the trypanosomes of Dourine a clear instance of a 

 trypanosome life-history, which, under normal circumstances, is not transferred into any other kind of host ; 

 and, under normal circumstances, Trypanosoma eqiUperdum must pass through whatever sexual stage it may 

 possess, its whole life-history in fact, in the body of the horse. Dourine can, however, like sU-eping sickness, 

 be inoculated fi'om boat to host by simple transmission of blood as well as by coitus ; in other words, the 

 faculty of being transmitted by simple inoculation of blood is shared by Trypanosoma equipcrdian, wherein no 

 other host is usually involved, as well as by Trypanosoma gambiense. In these circumstances, it is simply 

 natural, assuming flies to be the agents by which sleeping sickness is transmitted, to admit that this form of 

 transmission may be merely in the nature of a mechanical transference, and have no more relation to the 

 sexual act in the life-cycle than has the artificial withdrawal of blood from a horse infected with Dourine. 

 In other words, it would seem that the transference by flies in the case of sleeping sickness may have no more 

 significance with respect to the life-history of the parasite than has the direct inoculation of Dourine from 

 horse to horse by means of a needle. 



As regards methods of diagnosis, a recent paper by Martin and LebcBuf may be cited. 

 They have compared the value of the different methods employed for making a microscopic 

 diagnosis of T. gambiense. In all they examined 258 cases with a view to determining what 

 is the procedure which enables one to discover the trypanosomes (i) with the maximum 

 of certainty and (ii) in the minimum of time, and that which natives will submit themselves 

 to with the least outcry. They recommend : — 



1. Examination for 10 minutes systemically (a movable stage being employed) of 

 a fresh film of blood taken from the pulp of the finger, or preferably two such films taken 

 from two difl'erent fingers, the one from the right hand and the other from the left hand. 



2. If this first examination is negative, and if the patient has enlarged glands, these 

 should be punctured in the cervical region for choice. If the neck glands are too small, try 

 the sub-maxillary or inguinal. 



3. If the parasites can still not be found, take 10 c.c. of blood, centrifuge and examine 

 the leucocyte layer, making, if necessary, a couple of films. 



4. If the result be still negative, the case is probably healthy ; but, if necessary, and 

 there is no objection, proceed to lumbar puncture, removing 10 c.c. of the cerebro-spinal 

 fluid and centrifuging it for 15 minutes. 



Nattan-Larrier and Tanon-* advise scarification of the erythematous patches for detection 

 of the trypanosomes, which may be found in this way when absent from the blood. This 

 refers specially to white-skinned patients. 



Finally, the all important questions of prevention and treatment may be considered 

 together. 



A portion of the summary of Hodge's Uganda Eeport^ may be quoted with advantage. 

 He says : — 



(a) The distribution of sleeping sickness, which was pretty well known before, except in the case of the 

 Nile Province and the small epidemic near Elgon, has been confirmed, and the observations appear to connect 

 the disease more closely than ever with Giussina palpaHx. 



(b) Broadly speaking, the degree of infection and the distance of penetration (other things being equal) 

 into the hinterland is everywhere proportionate to the intensity of the infection and the prevalence of fly at 

 the corresponding lake-shore or river-side. 



(c) The enquiry has shown the limited extent of the " infective areas," in which alone sleeping sickness is 

 communicable to man, and the wide extent of the fly-free interior, in which it is not communicable. 



(d) The " infective areas " form a very small proportion of the epidemic areas, and the bulk of human 

 infections is due to comm\inication with these areas, while only a smaU minority is caused by actual residence 

 within them. 



(e) Investigation shows also the efficacy of clearing, when scientifically applied, the apparent feasibility of 

 segregation, and the importance of obtaining native co-operation, if possible. 



(f) By clearing or otherwise destroying the narrow "natural" range of Glossina palpalis, the wider 

 " following " range is abolished. 



(The narrow " natural " range appears to be about from 30 to 100 yards in width, being the strip of scrub and 

 undergrowth near water haunted by "the fly"). 



' Martin, Q., and Leboeuf (February 12th, 1908), " Diagnostic Microscopic de la Trypanosomiase humaine." 

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



" Nattan-Larrier, L., and Tanon (October 17th, 1906). Presse Midicale. 

 ' hoc. cit. 



* Article not consulted in the original. 



