THE SLEEPING SICKNESSES 



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It appears to us that Castellanella gamhiensis as seen on the West 

 Coast of Africa, and as originally described by Button and Todd, 

 requires more study, and we are supported in this by Macfie's work 

 with regard to C. nigeriensis, which we believe to be the same organ- 

 ism, and by the observations of Yorke and Blacklock at Sierra Leone. 



To summarize, we believe that though C. gamhiensis and C. 

 castellanii are morphologically similar, the clinical difference be- 

 tween the milder form of the disease as seen on the West Coast of 

 Africa and the terribly severe form found in Uganda is such as to 

 demand the separation of these two forms until it is proved that they 

 are really identical from a pathogenicity and serological point of view. 



History. — ^The earliest mention of sleeping sickness so far dis- 

 covered is by John Atkins, in his little book entitled ' The Navy 

 Surgeon,' published in 1734, in the appendix to which he describes 

 ' the sleeping distemper,' common among the negroes on the 

 Guinea Coast among whom he had travelled in 1721. In 1803 

 Winterbottom gave an interesting account of the disease as he met 

 with it on the West Coast of Africa near Sierra Leone. His descrip- 

 tion is quite understandable, and he draws attention to the presence 

 of the enlarged glands of the neck, the association of which with 

 the disease was so well understood that slave-traders would not buy 

 slaves who had enlarged glands. 



In 1808 Moreau de Jonnes described the disease in negro slaves 

 in the Antilles. In 1849 Clarke on the Gold Coast , Davis and Daniell 

 on the Guinea Coast, and Ferreira, came across it at St. Thomas. 

 During the next twenty years a number of observers described 

 sleeping sickness, among whom it is important to note that Guerin 

 met with it in 1869 in Martinique in negro slaves who had been 

 imported from Africa. In 1876 Corre gave a good description of 

 the disease as he knew it in Senegal. 



In 1891 the first case was brought to London, and was studied by 

 Sir Stephen Mackenzie; and in 1900 two more cases were brought 

 to London, this time under the care of Sir Patrick Manson. The 

 morbid anatomy of these cases was carefully studied by Dr. Mott, 

 who has done so much to clear up the pathology of this disorder. 



In 1901 Forde and Dutton found a trypanosome T. gambiense 

 (C. gamhiensis) Dutton, 1902, in the blood of a patient suffering from 

 a peculiar type of fever on the Gambia (Gambia fever, Dutton's 

 disease) , which was never thought by them to be connected with sleep- 

 ing sickness. In 1902-03 Castellani in Uganda found a trypanosome 

 in the cerebro-spinal fluid of persons suffering from sleeping sickness, 

 and in 1903 reported that it was the aetiological basis of the disease. 

 It was named Trypanosoma castellanii by Kruse in 1903, and on it 

 most of the work with regard to sleeping sickness has been done prior 

 to the discovery of Stephens and Fantham's organism. Low and 

 Castellani gave a cHnical account of the disorder which is largely 

 followed in this chapter, which, therefore, contains a clinical account 

 of the illness produced by C. castellanii. Low and Castellani called 

 attention to two constant symptoms which had not been remarked 



