AFRICAN TRYPANOSOMIASIS 145 



there may be rigidity of the neck and legs, a tendency to permanent 

 flexure of the legs, on the thighs, and abdomen. One case of mine 

 could not bend his legs at all, and danced with them quite stiff all day 

 and night, except when he was put down prostrate by attendants. He 

 could not rise again himself, but he continued to dance when he was 

 put in the upright position. 



Hypercesthesia is not common. They often wound themselves 

 against sticks, &c. ; ulcers form which are difficult to heal owing to 

 their reduced condition and their dirty habits. 



Daily fever is common when there are pneumonic symptoms, at 

 night up to ioo°-i04° F., falling to subnormal in the morning. 



There may not be any fever at all, or the temperature may be sub- 

 normal. There are no rigors or sweating in fever cases, but the pulse 

 is unusually quick, 90-140, and is out of all proportion to the tem- 

 perature. It is, as a rule, regular, readily compressible, and small. 

 Respirations are increased. There may be Cheyne-Stokes breathing 

 before death. Congestion and oedema of the lungs with pneumonic 

 patches are common before death. 



Digestion is good. Sometimes there is constipation, but more 

 often diarrhoea. Unclean feeding may account for it, e.g., fungi, 

 baked clay, &c. The usual intestinal flora can be found. 



The blood shows trypanosomes, auto-agglutination, mononucleosis, 

 and sometimes polyleucocytosis before death. 



The acidity of the blood is said to be increased, or probably better, 

 the alkalinity is diminished, which is probably due to amino acids 

 secreted by trypanosomes, and produced by the action of the amino 

 acids upon serum proteids. 



Sexual desire does not necessarily cease, neither does menstruation, 

 but they may disappear in some cases. 



The lymphatic glands become fibrosed, smaller and harder. 



The skin is usually dry and rough, but may be normal. 



Emaciation is common, but not the rule. Muscular weakness is 

 very marked, tremors are pronounced, saliva dribbles from the mouth, 

 urine and faeces are passed involuntarily, bedsores form, the pulse 

 cannot be felt at the wrist, the temperature is subnormal, coma, and 

 death . 



Perverted appetite is common ; they will sometimes eat earth when 

 good food is at their side. One case died from intestinal obstruction, 

 and 2I pounds of clay lumps were found in the intestines. Many of 

 the people, however, are earth eaters when in normal health. 



Theft is a common propensity, but it is certainly more marked when 

 this disease is present. 



Mania is common. One case was of a boy who attempted to drown 

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