

1905.|] «infected with Various Forms of Trypanosomes. 237 
(1) produce a toxin which acts as the irritant; (2) they wndergo morpho- 
logical changes in the blood or cerebro-spinal fluid; or (3) that the secondary 
or terminal infection with which nearly all these cases were affected 
(except three), with diplococci, diplo-streptococci, or occasionally other 
organisms such as cocci, Friedlander’s bacillus and bacillus coli, leads to 
the destruction of the trypanosomes. 
It is probable that the defences of the organism against bacterial 
invasion are lowered by the trypanosome blood infection. It has been shown 
that recently a large number of natives have been dying of pneumonia. 
The diplococcus is one of the most prevalent organisms found in the body. 
Again, negroes, owing to jiggers and other sources of infection by pyogenic 
organisms have therefore ready to hand a source of secondary or terminal 
infection. 
A very interesting case in this respect was Bara Risgalli ; this man for a long 
time had infection with Trypanosoma Gambiense in the blood; these organisms 
were also obtained from his lymphatic glands by Captain Greig. Sections of the 
glands removed during life were examined by me, and I found evidence of 
degenerated trypanosomes, macro-nuclei and micro-nuclei; also the glands 
showed marked evidence of chronic inflammatory change; plasma cells and 
degenerated cells being abundant. The gland removed during life was sterile, 
that is free from micro-organisms, and no diplococci could be discovered 
in the sections which I examined. At this time, he showed no signs of 
Sleeping Sickness ; later he was taken ill, and as I learnt from Captain Greig, 
he died in 10 days of pneumonia with cerebral symptoms. 
Examination of the brain showed a well marked acute pneumococcic menin- 
gitis; in fact, I should not have thought of Sleeping Sickness upon looking 
at the sections without prejudice, for the leucocytic infiltration was almost 
entirely confined to the membranes, consisted almost entirely of polymorpho- 
nuclears, and it did not extend into the peri-vascular spaces. Amid and 
within the leucocytes were immense numbers of diplococci with capsules ; the 
lymphatic glands, which were previously sterile, now all contained 
diplococci. Whether this man would in time have developed the chronic 
meningo-encephalitis of Sleeping Sickness and its associated progressive 
phenomena, I am unable to say; but it is an interesting point in connection 
with the fact that some authorities look upon the Zrypanosoma Gambiense as 
a distinct form from that which produces Sleeping Sickness. 
The European case, reported by Sir Patrick Manson, of a missionary’s wife 
who died in England with the lesion of Sleeping Sickness, having suffered 
for some time with trypanosome fever, and with Trypanosoma Gambiense 
in the blood, is opposed to the view of a distinct organism. It is possible, 
