70 THOMPSON YATES AND JOHNSTON LABORATORIES REPORT 
With regard to anaesthetics, cocaine is the best. Cases of excitement or mania 
necessitate chloroform, but it is inadvisable to give chloroform if it can be avoided, 
for, in two cases, the struggle and subsequent exhaustion have I believe hastened 
a fatal issue. 
The needle selected should be as fine as possible, consistent with sufficient 
strength to withstand the grip of the powerful back muscles, if in the early stages of 
the disease the patient is restless or insufficiently cocainised. In length it should be 
from two to three inches. It is important that the diagonal surface at the point 
should be as short as possible, and the actual point not too sharp. In no case 
should the syringe be used as a handle for the needle, but into the base of the 
needle should be screwed a metal handle, which, when the needle has been passed 
into position, can be substituted for a glass 10 c.c. serum syringe with a short rubber 
connexion. The careful sterilization of all instruments is of course necessary. 
Although the skin may be cleansed' as thoroughly as possible, it cannot be sterilized, 
but, in my cases, no introduction of septic matter has resulted from the operation. It 
would, however, probably be wisest, after the cocaine has been injected, to cauterize 
the site of the puncture with some small cautery made for the purpose. 
In the cases of septic meningitis, pus is frequently found in the ethmoidal or 
other sinuses, and the infection cannot be traced to the lumbar puncture. In Cases 7 
and 9, in Table II, and others in Table I, symptoms of meningitis were apparent 
before the puncture was made, and in other cases death occurred from the same 
cause without lumbar puncture. The discovery of purulent lymph round the cord 
in Case 31 might possibly point to infection introduced with the needle, but in this 
case the symptoms did not commence till a fortnight after the puncture. 
These notes are the outcome solely of work done in connexion with the Congo 
disease. 
The duration of the cases in Tables I and II is gauged chiefly by the date of 
the commencement of symptoms, that is in many cases the date at which the patient 
finds himself unable to work, the actual duration probably being much longer. The 
disease can frequently be diagnosed by the intimate friends or fellow workmen of the 
patient long before he himself realizes it. 
The total number of cases here recorded is too few to permit of any very definite 
statements, but 1 think it is sufficient to allow of the following provisional conclusions. 
1. That in many cases the trypanosomes never find their way into the cerebro- 
spinal fluid, and in those cases in which they do they are more likely to be found 
towards the termination of the disease. 
2. That the commencement of the fever or other symptoms is in no way co- 
related to the entrance of the parasites to the cerebro-spinal fluid. 
3. That a large number of trypanosomes in the cerebro-spinal fluid is rare, but 
when it does occur there is usually an access of temperature. 
