KEVIEW — TROPICAL MEDICINE, ETC. 



179 



4. Nevertheless, if the drug be persevered with, the parasites ultimately disappear for good and do not 

 return. 



5. Large doses of atoxyl are not necessary to secure this result. 



6. Large doses of atoxyl should be avoided, as they are apt to cause serious lesions, peripheral neuritis, 



suspension 



Sleeping 

 Sickness — 



continued 



of 



optic atrophy, gastro-intestinal iuflamraation, and other toxic conditions which necessitate 

 valuable remedy. 



7. Trypanroth, mercury and parafuchsin seem ineffective in human trypanosomiasis. 



8. Antimony may have a therapeutic influence in tryjianosomiasis, but the hypodermic injection of the 

 sodio-tartrate is impracticable. 



He considers the prospects of atoxyl treatment as being most hopeful, and suggests for 

 the routine treatment of trypanosomiasis a two to three grain dose of atoxyl every second 

 or third day and kept up for at least two years. Concurrent disease, such as malaria, 

 syphilis, etc., should be treated at the same time, and the patient should return to his native 

 country, be spared fatigue, worry, exposure and excess of all kinds, and be placed under the 

 most favourable hygienic surroundings. 



One may complete this review of Sleeping Sickness by tabulating the lines along which 

 further research should be conducted as formulated by Koch : — 



(a) The discovery of a method of artificially infecting Glossiim palpalis. 



(b) The comparative study of the trypauosoma found in Glossina palpalis in non-sleeping sickness areas 

 with the trypanosoma found in sleeping sickness areas. 



(c) The determination of the proportion of naturally-infected Glossina palpalis. 



(d) The determination of the period for which trypanosoma infection persists in (flonsina palpalis. 



(e) The use of the complemental method for the diagnosis of trypanosomiasis. 



(f) Experiments with new remedies. 



((/) Further investigation of the natural food supplies of the fly. 



{h) The study of the distribution of the fly on rivers and the conditions determining their presence. 



(i) Experiments for the purpose of infecting glossina reared from larveo, and of transmitting infection 

 by a fly reared in this manner. 



MesniP has recently reviewed the work of the members of the French Mission for the 

 study of the disease in the French Congo. The following points may be mentioned : — 



1. As regards the value to be attributed to glandular enlargement the French observers differ from 

 Dutton and Todd. They find that enlargement of the lymph glands is not synonymous with trypanosomiasis. 

 Many individuals exhibiting hypertrophied cervical glands do not suffer from the disease, and, conversely, 

 patients with trypanosomiasis have not always marked adenitis. 



2. He quotes the work of Martin and Lebceuf, already recorded, as regards the microscopic diagnosis of 

 trypanosomiasis. 



3. The rapidity which which Europeans are attacked on the Congo is insisted upon. 



4. Atoxyl alone is not sufficient to effect a cure. Picric acid has been given along with it internally, 

 and this method seems promising. 



5. Proof of the role of Olossina palpalis as carrier is to be found in the geographical distribution of 

 the fly and the disease, and the absence of the latter in the Antilles, into which it must have been repeatedly 

 Introduced in the old slavery days. 



6. It was noticed, however, in the French Congo that the number of cases of sleeping sickness in no 

 way corresponded to the number of Olossina palpalis present in the district. Thus, in places where tsetse flies 

 abounded, cases were no more numerous than in hilly districts, where there was little water and flies were few. 



7. Family infections were noted, but Koch's suggestion as regards spread by sexual intercourse cannot 

 explain the infection in children, and it is thought that mosquitoes of the genera Mansonia and Stegomyia, 

 especially the latter, may act as carriers of T. gamhiense. 



8. Roubaud has found that trypanosomes sucked up by a tsetse fly along with the blood of an infected 

 mammal are arrested in their passage along the insect's proboscis, and that they undergo modification and 

 evolution in its saliva with extreme rapidity. They become firmly fixed to the wall of the proboscis by the 

 extremities of their flagella, their undulating membranes completely vanish and their centrosomes change 

 position, becoming anterior to their nuclei. In short, they assume Herpctomonas forms. In this position they 

 multiply very abundantly during the first hour following the iusuction of the blood. Their duration of life 

 in the proboscis of the tsetse does not seem to be more than two days in the case of T. brticci, but for 

 T. dimorphon it is four and a half d.ays, and for T. yambiensc five days. 



This is regarded as a specific development, and it occurs only in tsetses which have 

 imbibed infected blood. Naturally this important observation requires confirmation, but it 

 is regarded as upholding the views of Bruce enunciated in 1904. 



These, then, are the main points in an interesting review of interesting and very 

 suggestive work. 



• Mesnil, M. (February, 1908), " Documents Pran^ais sur la Maladie du Sommeil.' 



IiitermU. D'Agroiwm, Ooloniale. 



Extrait., Assoc, Scicutif. 



