What, then, was to be done? Fortunately there was one man in the public service, recently appointed to be one of the chiefs of the educational arrangements of the Army Medical Department, who had shown himself to be especially gifted in the investigation of obscure diseases. This was Colonel David Bruce, F.R.S., who, some fifteen years ago, established the existence of Malta fever, as an independent disease, by his clinical observations and by the isolation and cultivation of the parasitic bacterium causing it; and who, further, when employed by the governor of Zululand a few years later (1895) to investigate the celebrated tsetze-fly disease of South Africa, had discovered, contrary to the assertions and prejudices of a large number of African sportsmen and explorers, that the horse and cattle disease known as nagana or tsetze-fly disease was due to the presence in the blood of the affected animals of a peculiar cork-screw-like animal parasite, the Trypanosoma Brucei. This is carried by the bite of the tsetze-fly from the blood of wild game, such as buffalo and antelope, where it does no harm, to the blood of domesticated animals, in which it multiplies and proves to be the source of a deadly poison causing death in a few weeks. The experiments by which Colonel Bruce demonstrated this relationship of tsetze-fly, trypanosome parasite, wild big game, and domesticated animals, were universally regarded as masterly both in conception and execution, and absolutely conclusive.
The committee of the Royal Society came to the conclusion that the thing to be done was to get Colonel Bruce to consent to proceed to Uganda, and to recommend the Foreign Office to obtain from the War Office the temporary detachment of Colonel Bruce for this service. Accordingly Colonel Bruce arrived in Uganda in the middle of March, 1903. Dr. Low and Dr. Christy had already departed, but Dr. Castellani was still at Entebbe engaged in the study of his streptococcus. He mentioned to Colonel Bruce on his arrival that he had on more than one occasion seen a trypanosome in the cerebro-spinal fluid of negroes suffering from sleeping sickness; but, inasmuch as Dutton on the West Coast and Hodges in Uganda had described a trypanosome as an occasional parasite in human blood, he had not considered its occurrence in sleeping-sickness patients as of any more significance than is the occurrence of Filaria perstans. Castellani regarded the trypanosome, like the filaria, as a mere accidental concomitant of sleeping sickness, the cause of which he considered to be the bacterial streptococcus which he had so frequently found to be present.
Naturally enough, Bruce was impressed by the fact that trypanosomes, of the deadly nature of which he had had ample experience, had been found, even once, in the cerebro-spinal fluid of sleeping-sickness patients; and he immediately set to work to make a thorough search for this parasite in all the cases of sleeping sickness; then under observation at Entebbe. He generously allowed Castellani to take part in the investigation, which resulted in the immediate discovery of the trypanosome in the cerebro-spinal fluid of twenty cases, out of thirty-four examined, of negroes afflicted with the disease; whilst in twelve negroes free from sleeping sickness the trypanosome could not be found in the cerebro-spinal fluid. Castellani returned to Europe three weeks after Bruce’s experiments were commenced, and announced the discovery, which has been, in consequence, erroneously attributed to him, although mainly due to Bruce.
Bruce continued his work in Uganda until the end of August, 1903, having been joined there by Colonel Greig of the Indian Army, who has continued the work of the Royal Society’s commission since Bruce left. Other valuable observations have been carried out by various medical men officially connected with the Uganda Protectorate. Bruce soon showed that in every case of sleeping sickness, when examined with sufficient care, the trypanosome parasite is found to be present in the cerebro-spinal fluid. He also showed that it is absent from that fluid in all negroes examined who were not afflicted with the disease, but made the very important discovery that the trypanosome is present in the blood (not the cerebro-spinal fluid) of twenty-eight per cent. of the population in those areas where sleeping sickness occurs, the persons thus affected having none of the symptoms of sleeping sickness, but being either perfectly healthy or merely troubled with a little occasional fever. The subsequent history of all the cases thus observed has not as yet been recorded. But in many such, even in some Europeans, the earlier presence of the trypanosome in the blood has been followed by its entry into the cerebro-spinal lymphatics, and by the fatal development of sleeping sickness.
As already indicated, it was found by Bruce, on recording the cases of sleeping sickness brought into or reported in Entebbe, that there were certain “sleeping-sickness areas” and other areas free from sleeping sickness. The theory now took shape in Bruce’s mind that the trypanosome first gets into the blood, and then after a time, makes its way into the cerebro-spinal system, only then producing its deadly symptoms. Very generally, when once in the blood, the trypanosome multiplies itself, and sooner or later—apparently, in some cases, even after two or three years—gets into the cerebro-spinal fluid. It is probable that it may be destroyed by natural processes in the human body before this final stage is reached; and thus the infected person may recover and escape the deadly phase of the disease. But nothing certain is known, as yet, on this head. Later observations show that the trypanosome is found alive and in large quantity in the lymphatic glands, especially those in the region of the neck in infected persons. These glands were known to be enlarged in persons suffering from the disease.
Colonel Bruce’s next step was to ascertain the mode in which the trypanosome is introduced into the blood. Naturally he looked for a kind of tsetze fly, such as carries the trypanosome in the nagana disease of horses and cattle already studied by him in Zululand. It is a fact that the Glossina morsitans and Glossina pallidipes, which are the tsetze flies of the “fly-districts” where nagana disease is rife, are unknown in Central or Western Africa; and also it is a fact that no tsetze fly had been observed in the neighbourhood of the Victoria Nyanza when Colonel Bruce began his enquiries. He employed, through the good-will of the native chiefs and rulers, a large number of natives to collect flies throughout the country forming a belt of twenty or thirty miles around the north of the lake. Many thousands of flies were thus brought in, and the localities from which they came carefully noted. Among these flies Colonel Bruce recognised a tsetze fly; and when these collections were received at the Natural History Museum in London, it was at once determined by Mr. Austen, the assistant in charge of our collections of Diptera (or two-winged flies), that the Uganda tsetze fly was not the same species as that of Zululand and the fly country, but a distinct species previously known only on the West Coast and the Congo basin, and described by the name Glossina palpalis. The story thus developed itself: the trypanosome of sleeping sickness is probably carried by this West Coast tsetze fly just as the trypanosome of nagana is carried in the south-east of Africa by the Glossina morsitans and pallidipes, the regular and original “tsetze” flies.
Sleeping sickness thus presented itself as a special kind of human tsetze-fly disease. To test this hypothesis, Colonel Bruce pursued two very important and distinct lines of enquiry. In the first place he found that those places on his map which were marked as “sleeping-sickness areas” were precisely those places from which the collected flies included specimens of tsetze fly, whilst he found that there were no tsetze flies in the collections of flies brought in by the natives from the regions where there was no sleeping sickness.
His second test inquiry consisted in ascertaining whether the tsetze flies of Uganda are actually found, experimentally, to be capable of carrying the trypanosome from one infected person to another. For this purpose it was necessary to make use of monkeys, certain species of which were ascertained to be liable to the infection of the sleeping sickness trypanosome when this was introduced by means of injection through a syringe. Such monkeys were found to develop the chief symptoms of sleeping sickness, and ultimately died of the disease, their cerebro-spinal fluid being invaded by the parasites. Accordingly it was possible to use monkeys as test animals. It was found by Colonel Bruce that tsetze flies (Glossina palpalis) which had been made to bite infected negroes could carry the infection to the monkeys; and it was also found that even when a number of tsetze flies, not specially prepared, were allowed to bite a monkey, the latter eventually developed the trypanosome in its blood and cerebro-spinal fluid, thus showing that the tsetze flies, as naturally occurring in the country around Entebbe, contain many of them, the trypanosome ready to pass from the fly to a human or simian victim, when casually bitten by the fly.
Experiments such as these of infection by the fly, and the use of monkeys in the research, require very great care; and it is quite reasonable to ask that they shall be repeated and most carefully checked before they are considered as demonstrative and absolutely certain. It may, however, be considered as practically certain that the sleeping sickness is due to the presence in the cerebro-spinal fluid of quantities of a minute parasite, the Trypanosoma Gambiense, which is carried from man to man by the palpalis tsetze fly, which sucks it up from the blood of an infected individual and conveys it to previously uninfected individuals. The natives in Uganda lie about and sleep under the shade of trees where the tsetze flies are especially abundant; and they are quite indifferent to the bites of flies of one kind and another.