DOURINE OR MALADIE DU COIT 33 



The first demonstration of the Trypanosoma Equiperdum was on February 11. 

 On this date the mucous membrane of the vulva, extending to the vagina, was dis- 

 tinctly orange tinged, slightly corrugated and oedematous. A well defined vesicle was 

 visible on the inner border of the right labium, and the base of the vesicle was a little 

 more than two centimetres in diameter, being raised, much firmer and more (Edematous 

 than the surrounding tissues. 



This small oedematous area, including the vesicle, was slightly scarified. Three 

 smear preparations were made of the sero-sanguineous fluid, in two of which the 

 trypanosomata were found. The organisms were very rare, 16 only being counted 

 after searching the whole of the smears occupying many hours. 



Trypanosomata have since been demonstrated in the vaginal mucvis or in traces 

 of blood from scarified oedematous points of the mucous membrane, more or less con- 

 stantly up to this date, March 16. (For detailed findings see table XI). 



The contour and general appearance of the vulva is slowly changing. (March 31, 

 1907.) A few small depigmented spots recently appeared at the edges of the labia, 

 gradually increasing in size until there is now a distinctly leucodermic area on either 

 side of the vulva. The mucous membrane is slightly everted, the clitoris totally de- 

 pigmented and the vulva tumefied. 



The mucus is very scanty, the inner borders of the labia and the clitoris being 

 pale and dry. The oedematous ' pinheads ' of the mucous membrane have disappeared 

 but on the floor of the vagina are two well marked oedematous areas, about 2J centi- 

 metres in diameter, straw coloured and semi-transparent. 



The temperature has assumed a more normal and regular curve. 



The appetite has never failed and the general condition has improved slightly, 

 though inco-ordination of the limbs is still apparent and the hind quarters sway from 

 side to side. 



Trypanosomata have been demonstrated in the sero-sanguineous fluid of the vagi- 

 nal mucous membrane, upon the following additional dates: March 20, 21, 23, 24 and 

 25. A few of the organisms appear to be assuming an amoeboid form, the body of the 

 parasite being much less elongated than usual, the nucleus large and the flagellum ab- 

 sent or unstained. 



Sexual excitement was manifested for a period of 5-6 months commencing four 

 months after infection, and was accompanied by pruritis. From March to June, 1907, 

 the condition was that of nymphomania save during this latter period, the mucous 

 secretion has at all times been scanty. The external genitals under surface, of tail 

 and inner sides of thighs have never shown evidence of a vaginal discharge. In June 

 and July, 1907, the depigmented spots and patches spreading from the muco-cutaneous 

 margins of the vulva had partially and at this date, (November 15), totally regained 

 their colouring matter, aad a normal appearance. Neither an ulcer nor a cicatrix has 

 ever been observed. Tumefaction of the labia has disappeared. The vaginal mucous 

 membrane remains swollen, tough and elastic. In small areas or patches there are 

 clusters of lymph follicles giving the membrane a finely nodular or puckered appear- 

 ance. 



CUTANEOUS MANIFESTATIONS. 



THE SO-CALLKD DOURINE ' PLAQUES.' 



No. 1. Appeared December 22, 1906. A small swelling about one centimetre in 

 diameter, oval surface, hardened skin, not pitting on pressure. Situation, posterior 

 left ribs. The swelling persisted for two days. Trypanosomata not found in smear 

 preparations from small incision. 



No. ^.—Appeared December 31. A small swelling similar to No. 1. Situated 

 on the lower portion of the right breast. Trypanosomata were not found in a blood 

 9459—3 



