I 3 6 



TROPICAL MEDICINE AND HYGIENE 



muscular pain Kerandel's symptom. In other cases the 

 slightest pressure on the muscles is acutely painful, and 

 putting a muscle on the stretch may cause so much pain 

 that the patient is unable to stand or walk. The cardiac 

 action is very rapid and unduly subject to irregularities 

 as a result of slight exertions. A fine muscular tremor 

 is often perceptible in the hands in late stages. The 

 appetite is good, and unless there is much pyrexia the 

 tongue is moderately clean and the bowels regular. 



FIG. 42. Child with trypanosomiasis showing oedematous swellings 

 of the eyelids. 



The disease runs a very chronic course in most cases, 

 but in some death may occur early from the seventy 

 of the disease, or from cardiac failure before the period 

 arrives when the temperature becomes nearly normal or 

 cerebral symptoms supervene. Intel-current diseases, par- 

 ticularly pneumonia, are often fatal, and with the subsi- 

 dence of the fever the general condition shows some 

 improvement, and the patient may be able to go about 



