1903.] in the Cerebrospinal Fluid in Sleeping Sickness. 507 



Table I shows that in 34 cases of sleeping sickness, the trypano- 

 somes were found in the cerebro-spinal fluid taken by lumbar puncture 

 during life in 20 cases, giving a rate of 70 per cent. 



On two occasions I also examined in the same way fluid from the 

 lateral ventricles and in both cases found the same parasite. In blood 

 I found the trypanosoma once with certainty. 



It may be thought that the trypanosomes are found in the cerebro- 

 spinal fluid on account of the trace of blood which sometimes forms 

 part of the sediment. But it will be seen from the table that in several 

 •cases there was no trace of blood. 



Table II shows that in 12 cases of ordinary disease, the cerebro-spinal 

 fluid taken during life by lumbar puncture, in no case contained 

 trypanosoma, and it is important to. note that 3 of these controls were 

 •cases of the usual trypanosoma fever, as described by Forde, Dutton, 

 Manson, Daniels, &c. 



Here it may be remarked that trypanosoma fever is by no means 

 uncommon among the natives in Uganda, 3 cases having been met with, 

 by Dr. Baker, one of the colonial surgeons here (Entebbe), within the last 

 3 weeks. I understand that Dr. Baker is publishing this most interest- 

 ing observation. It must be clearly understood that these cases of 

 trypanosoma fever bear no resemblance in their clinical features to 

 sleeping sickness. 



The trypanosoma found in the cerebro-spinal fluid of sleeping sick- 

 ness does not as far as I have been able to make out differ materially 

 in size and shape from the species one finds in the blood of trypano- 

 soma fever, Trypanosoma Gambiense (Dutton), but possibly it is to be 

 differentiated from this one, because in it, as a rule, the micro-nucleus 

 lies nearer the extremity and the vacuole is apparent^ larger. Besides, 

 its movements are not apparently so active, but this fact might be due 

 to the effects of the centrifuge. In case it should prove to be a new 

 species, the trypanosoma I have described might be called from the 

 country where I have found it first — Trypanosoma Ugandense. 



Belation of the Trypanosoma tc Sleeping Sickness. 



At the post-mortem examination of 80 per cent, of the cases where 

 I found during life the trypanosoma, I grew from the blood of the 

 heart and from the liquid of the lateral ventricles the variety of 

 streptococcus I described many months ago in my first note. Up to 

 that time I had never found the trypanosoma, but this is easily 

 explained by the fact that I did not use the technique I have described 

 in this note, viz., examination of a large quantity of liquid after long 

 use of the centrifuge. 



Influenced by my last investigations I would suggest as a working 

 hypothesis on which to base further investigation that sleeping sickness 



