i8 THOMPSON YATES AND JOHNSTON LABORATORIES REPORT 
Case 65. Mokoko. Male. Age twenty. 
History. — Patient is a lower Congo native, and conies from a district in which 
sleeping sickness is present. He left, his village a year ago, and has since been 
employed on a steamer plying on the Upper Congo. November 18, 1903, was 
admitted to hospital as a possible case of sleeping sickness. He says his illness com- 
menced about the middle of September, with pain in his chest and knees, and a 
waterv diarrhoea, no blood. These symptoms still continue. 
December 12, 1903. General condition : Patient is very thin, muscles wasted. 
He is very weak and can only stand or walk with difficulty. He lies by the fire all 
day long without sleeping, and when spoken to insists that he has not ' sleeping 
sickness.' He complains of diarrhoea, and pain and tenderness in both hypochondria 
and epigastrium. There is no marked oedema. Skm is dry and dirty, slight ' craw- 
craw.' Lymphatic glands all slightly enlarged and hard. Respiratory system, slight 
bronchitis. Circulatory system, heart normal. Abdomen, distended and resonant. 
Liver, lower border not easily made out, apparently normal. Spleen, normal. 
Nervous system, co-ordination and sensation to touch and pain normal. Reflexes, 
superficial and deep, obtainable ; each muscle contracts to flicking ; pupils react to 
accommodation and light. Patient's condition seems to be wholly due to dysentery 
and bronchitis. 
December' 27. Functional murmur at pulmonary second sound. 
January 5. Yesterday patient's blood showed over two hundred trypanosomes 
to the cover. His abdomen was distended and his feet oedematous, but there was 
little complaint. To-day the parasites are, perhaps, three times more numerous, the 
abdomen is more distended, and the feet oedematous. Patient complains of head- 
ache, pains in his joints, and of the abdominal distention. During these two days he 
has been more irritable, his breathing has been rapid and his skin moist. No 
murmurs. 
January 6. No trypanosomes in blood, symptoms much alleviated. With the 
exception of the last two days patient has for some time been in much better condition 
than when he was admitted. 
Faeces contain ova of Anchylostoma duodenale, Ascaris, and Trichocephalus dispar. 
January 18. There is no oedema. Abdomen is distended and partially 
tympanitic. He complains of headache, but is otherwise comfortable. Is much 
stronger and strolls about. 
January 28. Observations ceased, allowed to leave hospital. 
February 13. Patient seen walking about with steady gait and with exception 
of abdominal distention and slight wasting, appeared to be well and expressed himself 
as such. 
