SLEEPING SICKNESS 66 1 



into hospital he improves for a few days, but soon begins to 

 get worse again, becomes more drowsy, walks with increasing 

 difficulty, and finally lies constantly in bed. Fine tremors be- 

 come more marked — most noticeable in the tongue and arms. 

 The skin may become rough and dull ; eruptions are not 

 common. The patient becomes weak and emaciated. The 

 knee-reflexes, at first increased, become diminished, the motions 

 are passed involuntarily, and saliva dribbles from the side of 

 the mouth. The patient, becoming increasingly drowsy, is only 

 roused with difficulty, and this condition gradually passes into 

 coma. The temperature becomes constantly subnormal, con- 

 vulsions occur in a few cases, and the patient passes into a 

 condition of complete coma, and dies. 



In an acute case, the disease runs its course in about a 

 month or six weeks. In chronic cases, there is a slower de- 

 velopment of symptoms, which may remain practically unaltered 

 for considerable periods ; but eventually they pass on into those 

 of the later stages, and the disease ends fatally. 



Pathological Anatomy. — The changes are those of chronic 

 meningo-encephalitis and meningo-myelitis. The heart is flabby 

 and pale. Patches of broncho-pneumonia are common. Con- 

 gestion and oedema of the lungs are always present. The 

 liver has the appearance of chronic malaria, and the spleen, 

 much enlarged, often has a similar appearance, with character- 

 istic pigmentation. The stomach is sometimes dilated, and it 

 and the intestines occasionally show patches of congestion. 

 Parasitic haematodes are always found in the intestines. In 

 some cases Bilharzia ova have been found in the large intestine. 

 Tricocephalus dispar is always found in the ccecum. Enlarged 

 glands are found all over the body. Leucocytic infiltration is 

 found on the meningeal surface of the brain. The association- 

 fibres of the nerve-cells are diminished in number, and atrophied. 

 The diagnosis in early cases is difficult, the most important fact 

 being rise of temperature and increased rate of pulse. Later, 

 the diagnosis is easy. The prognosis, as previously stated, is 

 bad, this disease being always fatal. 



Treatment. — Many drugs have been tried, but none with any 

 permanent benefit. Mr. G. C. Low's investigations prove that 

 Filaria Persians is not the cause of sleeping sickness. There are 

 districts where Filaria perstans is common, yet sleeping sickness 

 is absent. In other districts sleeping sickness occurs, and Filaria 



