146 DISEASES DUE TO PROTOZOA 



himself. He was very fat, but he slept twenty-two hours out of twenty- 

 four. He recov'ered under treatment, so that he slept but ten hours 

 daily and went to work again. Some cases are very violent, and it is 

 impossible to inject them intravenously. 



GEdema of the eyelids, face, legs, arms, penis, scrotum and 

 abdominal w-all is fairly common in the final stages. Ascites may also 

 supervene, also an increase of the pericardial fluid. 



Irido-cyclitis and other eye troubles were so rare in my cases as to 

 be ignorable. My district was 4,800 sq. miles in extent, wdth a 

 population of from 100,000 — 200,000, of whom 75 per cent, were 

 infected with the disease. 



Some cases die from the disease without any enlargement of the 

 lymphatic glands, and others survive w'hen they have become markedly 

 enlarged. 



COMPLICATIONS. 



Pneumonia is common, and is one of the common terminal phases. 



Laryngitis, oedema of the glottis, and iritis have been recorded. 



Amoebic dysentery is fairly common, and usually causes death when 

 present. 



Cerebrospinal meningitis due to streptococci, pneumococci, or 

 meningitis is not uncommon. 



Epileptiform symptoms are frequent. 



Helminthiasis is common, but it may not give rise to any trouble- 

 some symptoms. Filaria may be present. 



Malaria is common in some districts and rare in others. 



Jiggers and resulting " tattered toes " are almost universal. A 

 considerable amount of septic absorption may result from ulcers caused 

 by them. 



DIAGNOSIS. 



The finding of the trypanosome is conclusive. 



Always suspect Trypanosomiasis when fevers are not controlled by 

 large doses of quinine in a trypanosome district. 



Look for erythema in Europeans. There will be a rapid pulse 

 during the apyretic periods. Asthenia without wasting should arouse 

 suspicions. Deep hyper^esthesia ; Kerandal's symptom is common in 

 Europeans. Tremor of the tongue; Low and Castellani's symptom 

 should be looked for. 



Cervical adenitis, Winterbottom's sign, is common and important. 



Search the blood for trypanosomes, auto-agglutination, mono- 

 nucleosis, but remember that auto-agglutination is also present in 

 Filariasis, Malaria, Syphilis and Yaws. 



