27: Sept. 15, 1914.) THE JOURNAL OF TROPICAL MEDICINE AND HYGIENE. [No. 18, Vol. XVII.

Original Communications.

SLEEPING SICKNESS IN THE LADO OF THE -ANGLO-EGYPTIAN SUDAN. By Avsert J. Cuatmers, M.D., F.R.C.S., D.P.H.

Director, Wellcome Tropical Research Laboratories, Member Sleeping Sickness Commission, Anglo-Egyptian Sudan, . AND 4 Captain W. R. O’Farrett, R.A.M.C.

Protozoologist, Wellcome Tropical Research Laboratories, Khartoum.

Introductory.—This paper is the first of hit it is hoped will be a series of ‘short notes on sleeping sickness in various parts of the Anglo-Egyptian Sudan; giving a condensed account of the known history and distribution of the disease associated with an attempt to define the parasite.

The experimental work has been performed in Khartoum, which is far removed from tsetse-flies and sleeping sickness. The material has been obtained by means of animals inoculated from sleeping sickness patients at Yei in the Lado Enclave of the Mongalla Province by Captain Ranken, R.A.M.C., and will be called the Yei strain or Yei trypanosome until the end of the present paper.

The only means available at the present time of differentiating trypanosomes is by comparative experiments performed as nearly as possible under the same circumstances of climate, place and time, and this is the reason why the work was not performed in a sleeping sickness area, because it was considered unjustifiable to introduce Trypanosoma rhodesiense into such area, as with all precautions an accident might: happen the. results of which might have been very terrible.

The strain of T. rhodesiense used was a Shrek descendant of the original strain discovered by Stephens and Fantham, of the University of Liverpool, to both of whom we are deeply indebted for so kindly giving us the living trypanosomes.

Therefore the two strains to be compared in this present paper have the following origins :— T. rhodesiense.—Lineal descendant of the original strain and brought alive from Liverpool in animals.

Yei strain.—Brought alive in an animal from Yei, the full history of which will be detailed later.

Patients were not brought to Khartoum for two reasons :— (a) Danger of spreading the disease by bringing individuals with trypanosomes in their peripheral blood through as yet uninfected fly regions.

(b) Desire not to hinder the treatment, which drives the trypanosomes from the peripheral blood and at all events temporarily benefits the patients.

The methods adopted for fixing and staining the trypanosome were as follows :— All films were fixed wet with osmic acid vapour for about four seconds and then plunged at once into absolute alcohol, in which they were kept for two to five minutes. They were then quickly washed with distilled water and transferred into the Giemsa's solution without allowing the films to dry. Z Two Giemsa’s solutions were used, viz. :— (A) A solution made up of 1c.c. of the ordinary stock stain with 10 c.c. of distilled water and two drops of a 1 in 1,000 solution of potassium carbonate in distilled water. | The films were stained in this solution for one hour or longer’ and were then rapidly washed in distilled water and dried.

(B) A solution made up of 2'5 c.c. of the ordinary stock stain with 100 c¢.c. of distilled water and five ~ drops of a 1 in 1,000 solution of potassium carbonate.

‘The films were stained from five to twenty-four hours in this solution and then washed in distilled water and dried.

‘Historical.—In order to make some of our remarks _ intelligible to any one who may read this note, it is necessary to review the history .of the discovery of the trypanosomes of sleeping sickness as we understand it, and then to pass on to a brief review of the history of sleeping sickness in the countries adjoining the Lado.

Human Trypanosomes.—The trypanosomes known to exist in man may, for our present purposes, be divided into those which cause— (a) South American trypanosomiasis (molestia de Oarlos Chagas) caused by Trypanosoma cruzi Chagas 1909.

With this disease and its causal organism we are not at present concerned. (6) The African Trypanosomiases, more commonly called sleeping sickness, with which we are concerned at present.

In 1901 Forde and Dutton found a ere Nairn, which, subsequently, received the name Trypanosoma gambiense Dutton 1902, in the blood.of a man suffering from a peculiar type of fever on the Gambia. This trypanosome was, we believe, brought alive to Europe; but, as after many inquiries we have failed to trace its present existence, we are forced to the . 66 eh : : ; conclusion that the original strain” of human trypanosomes is lost. This trypanosome was also named 7’. fordit Maxwell-Adams 28 March, 1903; and T. gambie Maxwell-Adams 28 March, 1903; other synonyms. are Z'. hominis’ Manson 1903, and T. nepveut Sambon 1 July, 1903. | In 1902 Castellani found a trypanosome in the cerebro- spinal fluid of persons suffering from sleeping sickness in Uganda.

On page 9 of the First Report of the Sleeping Sickness Commission of the Royal Society Castellani says :-— ‘‘The trypanosome found in the cerebro-spinal fiuid of sleeping sickness does not, as far as I have been able to make out, differ materially in size and shape from the species one finds in the blood of trypanosome fever, T. gambiense (Dutton), but possibly it is to be differentiated from this one because in it, as a rule, the micro-nucleus lies nearer the extremity and the vacuole is apparently larger. Besides, its movements are not apparently so active, but this fact might be due to the effects of the centrifuge. In case it should prove to be a new species, the trypanosoma I have described might be called from the country where I have found it first, “T. ugandense.””

This name suggested by Castellani, though the paper was written in April, 1903, would bear the date