676 INFECTION AND IMMUNITY. 



where he spends a long time in dozing" (Scheube). 

 For some time he is able to resist the somnolence, 

 and when aroused gives intelligent answers. He 

 eventually acquires an unsteady gait and walks 

 about like a drunken man. The temperature of 

 the body appears to be lowered, although irregular 

 attacks of fever occur. The somnolence gradually 

 becomes more intense, the patient grows very weak, 

 the pulse small and thready, respiration difficult, 

 the edema seen in trypanosomatic fever is rather 

 constant, incontinence of the urine and feces may 

 develop; the patient commonly dies after passing 

 into a state of deep stupor. Convulsions and pa- 

 ralyses are noted; the mind usually is clear when 

 the patient is conscious, although maniacal at- 

 tacks and delusions are occasionally noted. The 

 cervical and superficial lymphatics are frequently 

 but not constantly enlarged. A papulo- vesicular 

 eruption is quite characteristic and persistent and 

 the skin becomes very dry. The incubation period 

 varies from six to eighteen months, and the som- 

 nolent state from three to twelve months. Eecov- 

 ery rarely occurs. 



The essential anatomic change is meningo-en- 

 cephalitis ^ the soft mem branes being thickened, 

 containing a milky fluid and the vessels of the pia 

 and brain being surrounded by an extensive infil- 

 tration of mononuclear leucocytes. 



identity of The discovery of trypanosomes in sleeping sick- 

 T oJm5?c ness suggested that trypanosomatic fever may 



Fe sieep*ins really represent the long prodromal stage of sleep- 

 [ n g sickness. This view has been greatly strength- 

 ened by a case reported by Manson in which a 

 typical case of trypanosomatic fever was seen to 

 pass into typical and fatal sleeping sickness. The 



