HUMAN TRYPANOSOMIASIS 135 



of the disease in man. The period of incubation in 

 monkeys is about fourteen days. In some cases in 

 man it is even shorter. The onset in man appears to 

 be often confounded with malaria, but in some cases 

 there is high and continued fever as in typhoid, whilst 

 in other cases there is no marked fever. At this stage 

 there appear to be no characteristic symptoms, but 

 sometimes trypanosomes are found abundantly in the 

 blood. 



The temperature after this early stage may fall to 

 normal, and remain so, but even in these cases the 

 diurnal variation is usually increased, so that when the 

 temperature is taken frequently, though .it may rarely 

 exceed 99 F., there may be a variation at different times 

 of the day of as much v as 2 F. More frequently there 

 is slight irregular fever, the temperature rising to 100 or 

 101 F. every day. At times, in such cases, there will be 

 definite pyrexia, the temperature rising to 103 or 104 F., 

 or even more, for several days, falling gradually to normal 

 or a little above it. 



Some of the lymphatic glands are soon found to be 

 enlarged and are soft to the touch. They are not acutely 

 painful, but are tender on pressure. The glands at the 

 base of the neck are those most commonly enlarged, but 

 any glands may be affected. 



In Europeans a rash is usually present. It is evanes- 

 cent, but appears as erythematous rings surrounding an 

 area sometimes slightly discoloured by blood pigments. 

 This discoloration may amount to an actual bruised 

 appearance. The rings are not raised to the touch. The 

 chest, abdomen and covered portions of the body are the 

 usual sites for this eruption, but it may occur on any 

 other part of the body, such as the forehead and face. 

 Swellings of various parts of the body, and particularly 

 fugitive swellings under the eyelids, are sometimes seen. 

 There is progressive muscular weakness, some loss of 

 flesh, and anaemia, which may be profound. Even in 

 the early stages a slight blow may cause prolonged 



