57 
THE CEREBRO-SPINAL FLUID IN SLEEPING 
SICKNESS (TRYPANOSOMIASIS) 
104 LUMBAR PUNCTURES 
Second Interim Report of the Expedition of the Liverpool School of Tropical 
Medicine to the Congo, 1 903 
BY 
CUTHBERT CHRISTY, M.B., CM., Edin. 
THE majority of the punctures recorded in the accompanying tables were 
performed whilst working with Drs. J. E. Dutton and J. L. Todd, in the 
Congo Free State, All, with the exception of three, were performed by myself 
either at Boma, Leopold ville, posts further up the Congo, or since returning to 
England. Some conclusions drawn from a number of them are published in out- 
last conjoint report. 1 
Out of a total of sixty-four natives operated upon, the fifty-four in Table I were 
proved to be cases of sleeping sickness by the discovery of trypanosomes in the blood 
or cerebro-spinal fluid, or in* hydrocele fluid ; while in the remaining ten in Table II, 
parasites were never found, although the majority ot them were more or less 
suspicious cases, and all were in hospital at Leopoldville. 
In thirty-four of the fifty-four sleeping sickness cases the parasites were found 
sooner or later 111 the cerebro-spinal fluid, whereas in twenty of them no parasites 
could be found, although in one (Case 17) the fluid was examined on five occasions. 
If, however, those punctures in which the cerebro-spinal fluid was mixed with 
blood, and in which the parasites were found by coverslip examination to be present 
in the peripheral circulation on the same day as the puncture, be excluded, then we 
find that the result is very different, namely, forty-nine cases only, in twenty- 
five of which trypanosomes were found in the cerebro-spinal fluid, and twenty-four 
in which they were not found. 
A reference to Cases 19, 20, 21, will show how important it is to exclude from 
all statistics those punctures in which the fluid contains trypanosomes with blood cells 
when the parasites are known to be in the blood stream. Cases 20 and 21 show 
clearly that when the fluid is mixed with blood the number of parasites appearing in 
it is closely in proportion, not only to the number in the blood, but to the amount of 
blood admitted by unskilful puncture. I therefore in this analysis will exclude from 
consideration all punctures in which the cerebro-spinal fluid and the blood both show 
trypanosomes when blood is admitted into the fluid. In the Tables these are marked 
with an asterisk in the name column. 
I. Second Progress Report. 
I 
