Handbook of geographical and historical pathology. Vol. III. Ch. XIX, Negro lethargy / by August Hirsch ; translated from the second German edition by Charles Creighton.

August Hirsch

Date:: 1886

Credit: Handbook of geographical and historical pathology. Vol. III. Ch. XIX, Negro lethargy / by August Hirsch ; translated from the second German edition by Charles Creighton. Source: Wellcome Collection.

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$tcmia of the sinuses and vessels, vascularity of the brain-substance (particularly the cortex), its consistence normal apart from extreme hyperamia and softening of the corpus striatum and slight softening of the thalami, a small quantity of rather turbid fluid in the ventricles, with here and there an obvious thickening of the ependyma; the thoracic and abdominal organs perfectly normal. Griffon do Bellay also examined one cadaver and found the brain-substance and mem¬ branes congested, many punda cruenta, and the pons softened. In a case of Gore’s the membranes were congested, the brain healthy but. anasmic, about a scruple of serum in the ventricles; the thoracic organs quite healthy; several ecchymoses at the pyloric end of the stomach, the intestine for about three feet deeply congested and contracted, and with a considerable quantity of thick bloody fluid inside; liver, spleen, and kidneys normal. In one of his dissections,'Dangaix found the brain-membranes injected, a large quantity of flocculent fluid in the arachnoid space, exudation on the vertex, the cerebral substance very vascular and rather soft. In a second case (very imperfectly examined), the sinuses were distended, there was a small quantity of serum in tho ventricles, and the substance of the brain and of the cord as far as the cervical enlargement was of strikingly firm consistence. In a third case, besides hypertomia of the membranes, the serous exudation into- the arachnoid, and thickening of the latter with an exudation on the surface at a few spots, there was red softening approaching to lique¬ faction in the pons, thalami, and corpus callosum; thoracic and abdo¬ minal organs normal, excepting the liver which was somewhat enlarged, Clarke gives the results of five dissections. There was in all of them extreme hypernmia of the brain-membranes; in two there was opacity and thickening of them ; in one a serous exudation into the arachnoid mesh-work ; in one the cerebral substance anmmic, while in two others- it was highly congested; in two a slight amount of serum in the ven¬ tricles ; in one the ventricular serum tinged with blood; in one the corpora striata and thalami softened; in most of them the membranes of the cord congested; in two a large amount of blood extravasated in the cervical and dorsal regions of the spinal canal, and exudation besides in one of them; in three (boys from ten to fourteen years old) much fat. on the surface of the heart, in one of them with exccntric hypertrophy; in one case the latter condition without fat on the surface; nearly always certain appearances of pleurisy, and in two cases indications of pneumonia; in the majority, congestion of tho gastric mucous mem¬ brane, of the peritoneum, and of the cortex of the kidneys. Lastly, a fact adduced by Corre and Gore should be noted, namely, that in persons attacked by lethargy, and even beforo the disease was developed, enlargement of the lymph glands was relatively common, if not altogether constant, although its extent was very slight. Corre lays particular stress on this in his view of the pathogenesis, as we shall see. NEGRO LETHARGY. 599 \ § 188. Area of Distribution. The distribution-area of negro lethargy includes a large part of the West Coast of Africa between the Senegal and the region of the Congo ; there is no mention of it in the writings relating to Angola and Benguela, situated to the south of the Congo, and it probably does not occur in these territories. On the coast of Senegambia) the principal seats of it are the districts of Baol and Sin, especially the settlements of Portudal and Joal (Corre) ; it has been seen also on an island in the estuary of the Rio Grande, belonging to the Portuguese settlements (Gore). Of its occurrence in Sieinra Leone} wo have accounts by Clarke and Gore. The former says that it is more common among the tribes belonging to the interior than in natives of the coast; he speaks of it also among the free negroes of Cape Mesurado in Liberia. We hear of cases among the ICroomen on the Spice Coast and Ivory Coast (Santelli), among the natives of the Gold Coast (Clarke), on Fernando Po and other islands in the Bight of Biafra (Ritchie, Iglesias y Pardo), in the region of the Gaboon, not merely on the coast (Dumontier), but also in the interior chiefly along the course of the Ogooud (Ballay), and finally on tho Congo Coast (Dumontier, Griffon de Bellay). Wherever tho disease has occurred beyond those regious, it has been only in negroes imported from the West Coast, as in the French Antilles (Guadeloupe and Martinique). Among 1200 negroes who came under his observation during nine months, Nicolas saw five cases; he thinks that one in every hundred deaths among negroes on the voyage from the Congo to the West Indies is from lethargy, and that if the disease be commoner among negroes in their homes than under these circumstances, the reason would be that those of them who show the first or prodromal signs of the disease are left behind. During twelve years’ practice in Martinique Guerin saw 148 cases among imported negroes. Under similar circumstances the malady has been 1 See tho papers by Cliassaniol, Gore, Corre, Bcstion, Carbonel aud Abblart. 5 The frequency of tho disease in Sierra Leone is shown by the fact that 179 cases came under treatment by English practitioners in eleven years.$