142 DISEASES DUE TO PROTOZOA 



they may appear anywhere, but are usually on the trunk or thighs. 

 There may be solid intiltrated patches and rubeloid spots. 



A mottled and bluish appearance of ihe trunk is very important. 

 When once seen it is never forgotten, and could be seldom mistaken. 



Rarely a vesiculo-papular eruption is seen. 



There may be patches of painful local oedema about the hands or 

 feet readily mistaken for rheumatism. Many of these eruptions last 

 for a few days and reappear elsewhere. They are known as Trypanides. 



LYMPHATIC GLANDS. 



Enlarged, especially in the neck, posterior triangle; this is Winter- 

 bottom's sign. They are soft at first, elastic, and later become hard 

 and fibrous. They vary in size from a split pea to an almond. Few 

 become larger than this. 



Deep Hypercesthesia. — This is known as Kerandel's sign from a 

 physician who contracted the disease and described the condition. It 

 is general, and the pain on contact is intense. The slightest pressure 

 feels like a bruise and is exceedingly painful. 



A puncture with an hypodermic needle feels like a " red-hot poker " 

 in bad cases. An accidental knock by a walking stick gives ex- 

 cruciating pain. There is deep bone pain as distinct from deep muscle 

 pain. It is felt over the ribs, extremities, about the eyeballs, face and 

 head, so that wearing a helmet is painful. The leg pains have been 

 mistaken for beriberi. 



Localised Oedema. — One ankle may swell for a time and then the 

 swelling may disapj^ear. There may be (edematous patches over the 

 temple region or on the thigh. T>ater there is a more extensive oedema. 



Asthenia and Ancemia. — The anaemia may be marked and ]3ro- 

 gressive. Weakness is considerable, although no wasting may be 

 present. 



Eye Lesions. — Dr. Daniels has called attention to these, and 

 describes them as toxic irido-cyclitis, conjunctivitis, iritis, keratitis, 

 retinal changes, photophobia and deep oedema of the lower eyelids, 

 with deep ]5ain of the eyeball. Thev were lareh' j^resenl in my cases. 



Orchitis is present in some cases. 



This febrile stage may go on for Aears or it may be cured, either 

 spontaneously or by treatment or both, except in Rhodesian cases. 



The appetite is usual! \- good. Wasting is absent until the sleeping 

 sickness stage. 



The symptoms vary mucli in different individuals, no one showmg 

 all of them except in very few instances. A few of m\' European cases 

 chosen at random will indicate this point. 



Case (i). — In tr^panosome area for eight vears without leave 



