414 Major R. Ross and Mr. D. Thomson. Sleeping [May 2, 



smoothness and regularity of the graph suggest that there was no very great 

 error of observation. The blood was taken every day at about 10 a.m., but 

 on April 5 and 6 several counts were made daily. 



It will be seen that between February 16 and April 30 (73 days) there 

 were 11 rises in the number of the parasites. Up to April 7 there were 

 seven rises, at intervals of seven or eight days. During this period the 

 patient was given no atoxyl, but was treated with large doses of quinine 

 (30 to 40 grains) daily, with frequent doses of methylene blue, and with 

 trypan red on March 17, 18, 19, and 20. 



On April 5 it was decided to administer atoxyl again as shown on the 

 chart, together with mercury and other treatment. 



The temperatures were taken by the sister of the ward, and it will be 

 seen that there has always been a tendency to a slight rise in temperature 

 concurrent with the rise in the number of parasites — the two curves thus 

 confirming each other. Only the maximum and minimum temperatures are 

 entered in the accompanying chart. 



The great regularity of the rises can scarcely be compatible with a mere 

 chance distribution. It will also be observed that the rises were of two 

 kinds, namely, high rises and low rises ; and that the two kinds alternated 

 with regular periodicity until April 18, at which point the cycle appears to 

 have become distorted — probably in consequence of the treatment. Tlie 

 regularity of alternation of the high and low rises is so well marked as to 

 recall the picture of a double tertian malaria, and to suggest that two 

 independent sets of parasites may exist in the patient, just as often happens 

 in malaria. 



The large dose of atoxyl given on April 5 seems to have had no effect 

 whatever on the following rise ; but the succeeding rises were apparently 

 modified for some reason. The value of the enumerative method for thera- 

 peutical research is obvious. 



Of course, many other facts in connection with the case have been 

 recorded, and parallel work is being done on su])-inoculated animals and on 

 the parasites. It is, therefore, inadvisable to attempt at present any 

 discussion of the many interesting tlieoretical questions which arise. 



We are much indebted to tlie Director of the Sleeping Sickness P)ureau 

 (Dr. Bagshawe) for having given us references to the literature on tlie 

 subject of Bucli fluctuations. In the original case of Dutton and Ford it was 

 noted that the parasites varied in numbers, and that a parallel rise in the 

 patient's temperature occurred. Manson and Daniels* chart the number of 

 parasites compared with r)00 leucocytes; but the ermr of this method is 

 * ' British Medical Jowrnal,' JSlay 30, 1903. 



