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rence of the disease among negroes far removed from the endemic centres, as in the West: Indies and in Europe re Bacteria. Various kinds of bacteria have been described in cases of sleeping sickness and claimed to be the specific agents of the disease. In 1897, Cagigal and Lepierre™ found a bacillus in the blood of a case of sleeping sick- ness from Angola, and claimed that it was the cause of the disease. They stated that by inoculating rabbits with cultures of this bacterium they produced a disease resembling sleeping sickness and yielding the charac- teristic organism. Brault and Lapin,” who had a cul- ture of the bacillus sent to them, were unable to confirm these observations.

In 1899, Marchoux” suggested that Frdnkel’s diplo- coccus might be the cause of sleeping sickness. He made the autopsy of one case of sleeping sickness at Saint Louis (Senegal), and found the pneumococcus on the pericardium, but was unable to detect its presence within the cerebro-spinal system. Pneumonia was very prevalent at the time. a

In 1901, Broden™ examined several cases of sleeping sickness at Leopoldville (Congo), and found in the blood and in the cerebro-spinal fluid (post mortem) a bacillus which grew abundantly on potatoes. This bacillus was not agglutinated by the blood of patients suffering from sleeping sickness. The same year the Portuguese Government sent a Commission to Angola to investigate the etiology of sleeping sickness. Bettencourt and his colleagues” isolated’ a diplo-streptococcus from the cerebro-spinal fluid which they obtained by means of the lumbar puncture made during life or post mortem. Lumbar puncture was performed in nine cases. In six of these it gave positive results, the bacteria being easily isolated, in the other three the' examination of the direct preparations and the cultures gave negative results. This streptococcus was also found in the blood and in the lymph glands.

Quite recently a similar streptococcus has been seen ‘by Castellani who, together with Low and Christie, was sent by the Foreign Office and the Royal Society to study th2 disease in Uganda. Castellani” found the streptococcus in the blood and cerebro-spinal fluid of patients suffering from sleeping sickness, but he found it very rarely during life, and then only in the last stages of the disease. Indeed, he grew it once only from the blood, although he examined bacteriologically the blood of thirty-seven patients, and in each case repeated the investigation several times, and with different methods. He examined the cerebro-spinal fluid obtained by lumbar puncture in twenty-eight patients, but only five cases gave a positive result, and four of these were examined a few hours before death. Out of six bacteriological examinations of urine, he grew the microbe once. Bacteriological examina- tions of enlarged lymphatic glands removed during life were negative, and the examination of the spleen juice obtained by puncture during life was likewise negative.

It is difficult to say whether Castellani’s streptococcus is identical with the microbe described by the Portu- guese Commission. The Portuguese physicians first stated that their diplo-streptococcus grew very poorly

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on the ordinary culture media, and that they had never succeeded in obtaining cultures on gelatine. Recently, however, they have modified this statement and affirmed that, like the streptococeus isolated by Castellani, it grows very well on gelatine.

Castellani believes that the streptococcus he has found in cases of sleeping sickness is simply a variety of Streptococcus pyogenes because, as a rule, it differs some- what from the typical streptococcus. He thinks that its rdle in the etiology of sleeping sickness may be — similar to that of thé streptococci in scarlet fever and rheumatic polyarthritis.

The bacteria so far described in cases of sleeping sickness have probably nothing to do with the disease, and, indeed, the extensive bedsores which form towards — the close of sleeping sickness fully explain the presence of secondary parasites.

The two cases which were brought to London in 1898 were very carefully examined with regard to bacteria. Dr. Bullock” attempted to make cultures from the blood and from some enlarged cervical glands which were removed during life, but none of the cul- tures had grown at the end of three weeks; he therefore came to the conclusion that no ordinary micro-organism were contained in the blood or glands. At post mortem the cerebro-spinal fluid was examined for micro-organisms by cultures, &c., and various organisms, including diplococci, Streptococci pyogenes, and bacilli were found, but of, course no importance could be attached to these observations.

FARIA PERSTANS.

In 1891, while examining the blood of a case of sleep- ing sickness under the care of Dr. Stephen Mackenzie in the London Hospital, Manson discovered the larve of a new filaria, which, from their not observing the periodicity characteristic of F. Bancrofti, he called F. perstans. Water he found these same filarie im films of blood obtained from other cases of sleeping sickness on the Congo, and in 1898 he again found them in the two cases of sleeping sickness which were admitted into Dr. Abercrombie’s wards at Charing Cross Hospital. Struck by the constant presence ©} these filarie in cases of sleeping sickness, and by th singular correspondence which seemed to exist betwee! the geographical distribution of sleeping sickness ane of Filaria perstans, and paralleling the long incubatio! period of sleeping sickness with the fact that F. persta can remain alive within the body of its host years atte the infection area has been quitted, Dr. Manson, with out committing himself, very reasonably suggested th this peculiar blood-worm might possibly be the cause ¢ sleeping sickness. When it was discovered that perstans was found not only in cases of sleeping sie ness, but also in a large proportion of the inhabitan of the Congo and of other parts of West Africa, B Manson still held to his hypothesis, because it was supported by the pathology of F. Banerofti. In fact, F. Bancrofti does not always cause chyluria, yet there can bé no doubt that it is, within the Tropics, am in many sub-tropical countries, a frequent cause— chyluria. The discovery of the presence of F. perstans in Briti 8 Guiana was very much against the theory of a conne