1266 



THE AFRICAN TRYPANOSOMIASES 



for the lymphatic tissues of the intestine (soUtary or agminated 

 glands) are also inflamed, and the heart and other organs infiltrated 

 with lymphocytes. This stage is marked by fever, but sooner or 

 later, as a result of this lymphatic disease, changes are induced in 

 the membranes and substances of the brain and spinal cord (chronic 

 meningo-encephalitis and meningo-myelitis), especially along the 

 course of the vessels, which result in the proliferation of the neuroglia 

 and in a lymphocytic accumulation around the vessels. These two 

 processes compress the vessels, and lessen the supply of blood to 

 the cells of the brain and spinal cord, in which, as the result of 

 malnutrition, changes ensue, which produce the typical symptoms 

 of the cerebral stage of the disease, which is often called ' sleeping 

 sickness.' The trypanosome apparently cannot pass through the 

 placenta, as infected women give birth to healthy babies. 



Towards the end secondary infections with bacteria may take 

 place, the most constant of these being due to streptococci and the 

 pneumococcus, which probably shorten the life of the patient. 



Cerebrospinal Fluid. — ^The cerebro-spinal fluid was first studied 

 by Castellani, and it may be noted here that it was during his 

 researches on the leucocytic formula that he discovered trypano- 

 somes for the first time in sleeping sickness. More recent researches 

 are those by Broden and Rodhain and others. During the first 

 stage of the disease it is usually of normal appearance and clear, 

 while on centrifugalization there is practically no sediment, though 

 occasionall}^ a few small mononuclear cells may be present, and 

 trypanosomes are, as a rule, absent. 



In the sleeping sickness stage it is often slightly turbid, and con- 

 tains an amount of serum albumen and serum globulin; and on 

 centrifugalization some sediment is obtained, consisting of a few 

 cells, which are mostly mononuclear leucocytes, endothelial-like and 

 vacuolated cells, while trypanosomes are almost constantly present, 

 and also often aflagellate, roundish, or oval forms, with one or two 

 chromatin masses, as described by one of us in 1903. These may 

 probably be compared to the so-called latent forms described in 

 the spleen by Breinl and others, though Laveran and other authori- 

 ties consider them to be degenerated or fragmented forms. 



Morbid Anatomy and Histopathology. — ^The macroscopical changes 

 found post mortem are principally in the central nervous system 

 and in the lymphatic glands, but pathological changes brought 

 about by complications may also be noted. 



The body is usually emaciated and anaemic, rigor mortis is well 

 marked, and the skin may be normal, or dry and desquamating, 

 or may show pustular eruptions on the hands and forearms, or ulcers 

 on the feet which are generally due to jiggers {Dermaiophilus pene- 

 trans) . Enlargement of the lymphatic glands of the neck and.groins 

 is generally easily seen. On opening the brain-case, it will be noted 

 that the under surface of the scalp is pale, that the dura mater 

 may or may not be adherent to the bone, that the cerebro-spinal 

 fluid is increased in quantity, and the gyri of the brain are often 



