380 



MEDICINE, ADVANCES IN. 



way overlap. The stained leucocytes can be 

 readily distinguished from the red corpuscles. 

 The average number of leucocytes in each field 

 is then determined, and this is called y. The 

 larger the number of fields of vision counted, the 

 more accurate will be the result. If the blood 

 has been diluted 100 times the number of leuco- 

 cytes per cubic millimeter may be found by the 



, 5.600000 y 

 following formula: 



1 1 J* 



J and y only have to be determined, and a 

 simple calculation gives the result. " Such a for- 

 mula is available for any microscope and for any 

 eyepiece." 



* The Sleeping Sickness. A curious disease 

 of the brain variously called the " sleeping sick- 

 ness," " sleeping dropsy," " negro lethargy," etc., 

 has been occasionally mentioned by medical trav- 

 elers in certain portions of Africa. But very lit- 

 tle has been known regarding its causes and 

 symptomatology, as owing to its comparative 

 rarity it passed for a long time unnoticed by the 

 modern pathologist. 



A considerable increase during recent years in 

 its ravages in the Uganda district, and on Prin- 

 cess island and the province of Angola, has final- 

 ly led both England and Portugal to send out 

 commissions for studying it. The report of the 

 Portuguese commission, which worked on Prin- 

 cess island, is summarized in the following ac- 

 count: 



The most remarkable symptom of the disease 

 is fits of absolutely uncontrollable sleepiness. At 

 first these can be partially overcome, but as the 

 disease progresses they not only increase in fre- 

 quency, but become so entirely irresistible that 

 the patients fall asleep with their mouths full of 

 food, or while drinking. The sleeping finally be- 

 comes almost continuous. It is not so deep, how- 

 ever, that the patients can not be aroused, even 

 as the end approaches it is almost always 

 fatal but they immediately fall asleep again. 

 According to Dr. Patrick Manson, the onset of 

 the disease is preceded by a lightening and red- 

 dening of the, hair. The disease is almost en- 

 tirely limited to negroes. In the early stages 

 there seem to be no marked mental changes, but 

 later there is nearly always great depression of 

 mind. According to Dr. Manson, the disease as 

 observed in the Congo is. frequently attended by 

 insanity. Usually, even up to the fatal day, the 

 sufferer understands and answers questions when 

 aroused, and shows signs of pleasure one pa- 

 tient smiling when presented with a cigarette 

 a few hours before his death. The memory seems 

 to be but slightly impaired, but the will and 

 power of concentration are markedly weakened 

 almost from the start. The senses sight, hear- 

 ing, and taste remain active to the last. Some- 

 times during the early stages of the disease, be- 

 tween the fits, instead of the usual depression 

 there is excessive and noisy hilarity, every oc- 

 currence being an excuse for " boisterous guffaw- 

 ing." 



A number of pathological bodily conditions 

 were found in the various organs (for which see 

 the report of the commission published in the 

 London Lancet, Sept. 27, 1902, p. 885), but the 

 most marked and constant changes were found 

 in the brain. 



The cephalo-rachidian fluid, a small amount of 

 which is present in the ventricles of the brain 

 and canal of the spinal cord in health, was al- 

 ways found to be considerably increased in quan- 

 tity and slightly turbid, although not purulent. 

 The increase of fluid was accompanied by in- 

 flammation of the membranes of the brain, vary- 



ing much in extent and severity in the different 

 cases, but always present to some extent. 



Microscopic sections of the brain substance 

 showed an infiltration with leucocytes. 



Bacteria were of course suspected and searched 

 for. In the vessels of the pia mater, in the cere- 

 bral and medullary capillaries, in the cephalo- 

 rachidian fluid and in the brain substance itself 

 there was constantly found a diplo-strepto- 

 coccus, which measured from 1.5 jito 2.0 (tin diam- 

 eter. It was found very difficult to cultivate this 

 coccus artificially, although a slight growth wus 

 obtained on a culture medium of ascitic fluid 

 and meat broth in equal proportions. Guinea- 

 pigs and pigeons were unaffected by inoculations 

 with the coccus, but rabbits were somewhat sen- 

 sitive, and it was fatal to mice. 



The conclusion reached by the commission 

 was that the disease is a form of meningo- 

 cephalitis, and that treatment " will be difficult, 

 but may be possible in the early stages." 



At Princess island the exciting cause of the 

 disease appears to be excessive labor, poor food, 

 and bad sanitation. All negroes of either sex 

 are liable to contract it, except those over forty 

 years of age. From one of the cases examined 

 some ground is given for believing it contagious. 

 These people eat from the same bowl with their 

 fingers, and lick the latter after each mouthful. 



Nothing could be learned regarding the incuba- 

 tion period. The onset may be sudden and 

 marked by furious delirium with homicidal tend- 

 encies, but it is commonly preceded by a period 

 of general malaise, lack of appetite, and inca- 

 pacity for work. 



At a meeting of the pathological and micro- 

 scopical section of the Liverpool Medical Insti- 

 tution on Nov. 13 Dr. W. B. Warrington stated 

 that the stress of the disease falls upon the lym- 

 phatic system, and especially that of the central 

 nervous system. His observations agreed with 

 those of Dr. F. W. Mott and supported the toxin 

 view. 



Alcohol in the Human Body. The Practi- 

 tioner devotes its issue for November, 1902, to an 

 exhaustive discussion of the alcohol question 

 from the medical point of view. It has obtained 

 the views of eminent English physicians such 

 men as Sir Samuel Wilkes, Sir Henry Thompson, 

 Sir William Broadbent, Prof. G. Sims Woodhead, 

 and J. Milne Bramwell. Regarding their per- 

 sonal use of alcohol, Sir Samuel Wilkes has been 

 a teetotaler practically throughout his working 

 life, Sir Henry Thompson found his health much 

 improved after stopping the use of alcoholic bev- 

 erages, and Prof. Sims Woodhead attributes his 

 early success in athletics and his present ability 

 to do a good day's work largely to total absti- 

 nence. James Edmunds, of the London Temper- 

 ance Hospital, gives statistics that indicate a 

 considerably longer life among the total abstain- 

 ers than in the case of even the so-called mod- 

 erate drinkers. The general opinion of three of 

 the practitioners may be summed up in the state- 

 ment that alcohol is a useful drug, but a danger- 

 ous beverage. 



In a recent memoir on alcohol (sixth memoir 

 of the eighth volume [1902] of the National 

 Academy of Sciences) W. O. Atwater and F. G. 

 Benedict first call attention to the fact that 

 as alcohol contains no nitrogen, it can not build 

 or repair tissue, and hence that its only food 

 value must lie in its heat-producing qualities. 

 This function may be fulfilled in two ways: 

 First, indirectly by stimulating secretion and the 

 digestion of other food, and, second, by its own 

 oxidation. Alcohol as a food can only be com- 



