558 TRYPANOSOMIASIS 



of the nerve cells, a diminution of Nissl's granules, and an 

 excentricity of the nucleus. 



Trypanosoma gambiense. Before going further we must 

 refer to the observation of a trypanosome in the blood of persons 

 not evidently suffering from sleeping sickness. The first case of 

 this was recorded by Dutton in 1901, the patient being a 

 European then living at Bathurst on the Gambia. The progress 

 of the disease was here very slow, and was characterised by 

 general wasting and weakness, irregular rises of temperature, 

 local oedemas, congested areas of the skin, enlargement of spleen, 

 and increased frequency of pulse and respiration ; death occurred 

 a year after the case came under observation after an access of 

 fever, and a striking fact was the absence of any gross causal 

 lesion. During the time the patient was under observation 

 trypanosomes were repeatedly demonstrated in the peripheral 

 blood, and they also developed in the bodies of monkeys 

 and white rats inoculated with the blood. Pursuing further in- 

 quiries, Dutton and Todd demonstrated similar parasites in other 

 Europeans and in several natives in the Gambia region, whilst 

 about the same time Manson reported a case of the same kind in 

 the wife of a missionary on the Congo. It thus came to be 

 recognised that in man there occurred a disease having characters 

 somewhat resembling nagana and in which trypanosomes could 

 be demonstrated in the blood, and this was usually referred to as 

 human trypanosomiasis, or trypanosoma fever, the trypanosome 

 being named the Tr. gambiense. 



Relation of Trypanosomes to Sleeping Sickness. Several 

 views as to the etiology of this disease had been advanced. A 

 Portuguese Commission in 1902 described a diplococcus tending 

 to grow in chains which they isolated from the cerebro-spinal 

 fluid taken from cases during life, and to which they were 

 inclined from the constancy of its occurrence to attribute a 

 causal role. The seriousness of the epidemic in Uganda had led 

 the Royal Society of London in 1902, at the instigation of the 

 Foreign Office, to despatch a Commission to investigate the 

 condition on the spot. Soon after commencing work, Dr. 

 Castellani found in some cases in the cerebro-spinal fluid, 

 especially when this was centrifugalised, living trypanosomes 

 resembling the Tr. gambiense ; he also found in 80 per cent of 

 the cases post mortem a coccus resembling if not identical with 

 that observed by the Portuguese Commissioners. At first 

 Castellani was inclined to look on the presence of the protozoan 

 as accidental, but Colonel Bruce on going out with Nabarro 

 and Greig in 1903 to pursue the work of the Commission 



