AFRICAN TRYPANOSOMIASIS 143 



(Central Africa). Fever almost constantly for months past, did not 

 take quinine, marked anaemia, weakness marked, pallor, spleen nearly 

 reached iliac crest, liver slightly enlarged, malaria also present, pains 

 in legs and calves excruciating, worse at night, exhausted because no 

 sleep, aspirin, bromides, trional, opiates useless. Sent to me as beri- 

 beri. No trypanosomes in blood, no auto-agglutination, no eruptions, 

 no eye lesions, pains in legs, with polyadenitis chief symptoms. Sent 

 home and diagnosis confirmed. 



Case (2). — In trypanosome area, Central Africa, three years; some 

 fever, probably malarial, trypanosomes found in blood, some auto- 

 agglutination, polyadenitis, no other disease present, strong man at 

 work and refused treatment, as no symptoms when first diagnosed. 

 Given soamin intramuscularly and sent home. 



Case (3). — History exactly as above. A very stout, strong man. 

 Given tartar emetic intravenously and Fowler's solution by the mouth, 

 and sent to Europe. Dr. Daniels writes some months later that he 

 does not find any symptoms of the disease in him. 



Case (4). — In trypanosome area six months. Central Africa ; an 

 ideal man, physically and mentally, prior to attack; marked weakness, 

 stubborn fever would not yield to quinine, frequent micturition for six 

 months, sleeplessness, nervous prostration marked, admitted to hospital 

 unconscious the day after the fever commenced. Temperature remained 

 up for five days, in spite of quinine 30 grains daily, no malarial 

 parasites in blood, no trypanosomes found after forty-two examinations, 

 no auto-agglutination, polyadenitis marked. Long convalescence, 

 prolonged weakness, memory poor, headaches, marked mottling of 

 chest, back and thighs, purple colour, disappeared on pressure, deep 

 pains of legs and muscles excruciating, then over body, face, head, 

 agonizing pain on the slightest touch. Erythematous patches, fleet- 

 ing, red, not raised, massage impossible, worse at night, as if " some- 

 one was twisting his legs off at the ankle," opiates of little use. 



All the typical symptoms were present, except trvpanosomes, auto- 

 agglutination and eye lesions. 



Was given Tartar emetic intravenously; ditto Galyl ; Soamin bv the 

 mouth and intramuscularly. Temperature normal for ensuing eight 

 months; when discharged all symptoms disappeared except slight leg 

 pains. 



Natives may show some of these symptoms, but in my cases (over 

 4,000) there were no eye lesions, except oedema and one persistent 

 double conjunctivitis not otherwise accounted for. 



Deep pain is very rare, fever also, but a dry, scalv eruption is fairly 

 common. Headaches, delusions, hysteria and mania are common. 

 Qidema of all parts common. Trypanosomes rare and aulo-aggutina- 



