12 70 



THE AFRICAN TRYPANOSOMIASES 



a crescent may be produced. This circinate eruption may appear 

 on any part of the body, but is especially frequent on the trunk; 

 in some cases, instead of rings, solid infiltrated patches, the size of 

 a half-crown or larger, are present. Rubeloid spots and a mottled 

 appearance of the skin are not rare. A vesiculo-papular eruption has 

 also been described, but is rare in our experience. Dermatographia 

 is common in Europeans. In full-blooded negroes the erythematous 

 eruption may not be noticeable; in them very often a dry, scaly 

 condition of the skin is found. These various eruptions are called 

 Trypanides. Patches of localized oedema may be seen in some cases. 



The most typical sign of the disease in tliis stage is enlargement 

 of one or more lymphatic glands, especially those of the neck, in 

 the posterior triangle (Winterbottom's sign.) The enlarged glands 

 are in this period generally fusiform, and of rather soft consistency. 

 Another early symptom, noted by Kerandel, is a general, intense, 

 deep hypersesthesia. As repeated attacks of fever increase, the 

 patient may become anaemic and asthenic, but the febrile condition 

 may last for years, and, indeed, in this stage the disease may be cured. 



Fig. 640. — Sleeping Sickness, Late Stage, in Anglo-Egyptian Sudan. 

 (Photograph kindly lent by Colonel A. Balfour.) 



The Cerebral Stage (the So-called Sleeping Sickness). — ^After the 

 febrile stage has lasted some time (weeks or months), and even years, 

 a change begins to appear in the habits and disposition of the 

 patient. Previously bright, intelligent, and hard-working, he be- 

 comes apathetic, dull, with a disinchnation for exertion, preferring 

 to sit quietty or to lie down. He also becomes careless in his work 

 and dirty in his habits, and at the same time a difficulty in walking 

 begins to be noticed. In this condition the sleeping sickness stage 

 of the disease may be said to have been properly entered. Typi- 

 cally, the patient is dull and apathetic, but can be easily roused, ancl 

 answers questions rationally, without difficulty in speech. Sleep 

 may be excessive, but is not the prominent symptom so often de- 

 scribed, the condition being more one of lethargy, from which the 

 patient can be easily roused. Fine tremors are noticed in the 

 tongue at first, later in the hands and arms, and sometimes also in 



