36 THOMPSON YATES AND JOHNSTON LABORATORIES REPORT 
Secondary Infections and Complications 
Secondary bacterial infections seem to determine the fatal issue of many cases of 
Congo sleeping sickness. Thirteen out of twenty-two necropsies performed at 
Leopoldville showed complications or obvious secondary infections. 
They were as follows : — 
Purulent meningitis ... ... ... ... ... ... ... 4 
Purulent pleurisy and pneumonia ... ... ... ... ... 1 
Pneumonia and localized tubercle of lung ... ... ... ... 1 
Localized gangrene of lung ... ... ... ... ... ... 1 
Enlarged caseating and breaking down glands in thorax and abdomen. 
No tuberculous lesions in organs (tubercle bacillus in glands 
seen in one case) ... ... ... ... ... ... 1 
Dysenteric ulceration of large bowel (perforation in one case) ... 2 
Universally adherent pericardium (recent) ... ... ... ... 1 
Infiltration of pus in femoral, inguinal, and internal iliac glands 
(gonorrhoea) ... ... ... ... ... ... ... 1 
According to the Post-mortem Reports of Colonel D. Bruce and Dr. Nebarro 
very similar lesions were observed in Uganda, where ten out of twenty autopsies 
on sleeping sickness patients showed obvious secondary infections and in three 
instances purulent meningitis. 
It will be noted that purulent meningitis has been the most frequent complication 
both in Uganda and in the Congo. The brain in these cases (see case 69) presents 
a very abnormal appearance. The convolutions, especially on the upper surface, are 
covered and glued together by a thick layer of tenacious lymph, and the vessels of 
the pia arachnoid are intensely congested. It is evident that such morbid changes 
are explicable on bacteriological grounds, and we have found, microscopically, in all 
such cases an almost pure culture of a diplococcus occurring in small chains. These 
observations make us doubt whether the acute congestion of cerebral vessels 
accompanied by an increase of pia arachnoid fluid containing pus cells, seen by us 
here, and described by others as typical of sleeping sickness, can be attributed to the 
trypanosome alone. 
The Portuguese Sleeping Sickness Commission, 1 Dr. Broden in Leopoldville, 2 and Dr. Castellani 
in Uganda, 3 have all described bacterial infections in a very large percentage of sleeping sickness cases 
examined before as well as after death. 
It must be noted that such purulent changes have not been described in animals 
dying from other trypanosome infections. 
1. Bettencourt, Koppe, de Rezende and Mendes, La Maladie du Somnetl, 1903. 
a. Broden, Ibid. 
3. Castellani, Report of the Sleeping Sickness Commission, Royal Society. 
