SYMPTOM A TOLOGY 



1271 



the legs, and even in the abdominal muscles. The tremor of the 

 tongue and hands may be a very early symptom and may be present 

 in the febrile stage. These tremors may occasionally be so severe 

 that they cause the whole body to shake, and at times epileptiform 

 fits, general or localized, may be seen. The gait is peculiar, there 

 being apparently a difficulty in raising the feet, so that the patient 

 shuffles along; but there is no paralysis as a rule, and the superficial 

 reflexes are normal; the deep reflexes may be exaggerated and then 

 lost; there is no clonus. There is inco-ordination in some cases, 

 and Romberg's sign may be present. As the disease advances, 

 rigidity appears, especially in the muscles of the neck and legs, 

 which latter may assume the position of flexion of the thighs on the 

 abdomen and the legs on the thighs. Babin ski's sign is generally 

 absent. Sensation is at first normal, but there may be hyperaesthesia 

 in the region of the fifth nerve and other nerves, and at times the 

 patient complains of headache. The pupils are equal, moderately 

 contracted, and react to light and accommodation. There is nothing 

 abnormal in the organs of special sense as a rule. There is usually 

 fever, the temperature rising in the evening from 100° to 104° F., 

 and falling to subnormal in the morning; but this may be varied 

 in many ways: thus for a period the temperature may be almost 

 normal or subnormal, while for some days before death it becomes, 

 as a rule, permanently subnormal. 



There are no special symptoms, such as rigors or sweating, asso- 

 ciated with the rise of temperature. The pulse is quick (90 to 140), 

 but it is independent of the temperature, being quick with a low 

 temperature. It is regular, but small and very low in tension, and 

 generally is imperceptible at the wrist for some time before death. 

 The heart as a rule shows no abnormal symptoms, though systohc 

 inorganic murmurs may be present. The respirations are regular 

 and equal, but are increased in number, especially towards evening, 

 varying from 20 to 30; before death they not uncommonly take on 

 the Cheyne-Stokes type. Congestion and oedema, with patches of 

 pneumonia, are not infrequently met with before death. The 

 appetite is good, and may even be increased; digestion is usually 

 satisfactory, but constipation may be marked, or there may be occa- 

 sionally diarrhoea. The tongue is frequently flabby and covered with 

 white fur ; the faeces of native patients are typical of a vegetable diet, 

 and show the usual parasites of a tropical country. The spleen and 

 liver may be enlarged, which perhaps may partly be due to malaria. 



The Blood. — -The examination of the blood is complicated, because 

 its condition is bound to be influenced by the secondary infections 

 with other parasites, animal and vegetal. 



With this understanding trypanosomiasis causes in a certain 

 number of cases a gradual diminution of the red cells to 2,000,000 

 or less, with a corresponding decrease in the haemoglobin; but it is 

 to be noted that, as first observed by Low and Nabarro in several 

 cases, the actual number of erythrocytes may be above normal. 

 The red cells are usually normal in appearance, but normoblasts 



