2o THOMPSON YATES AND JOHNSTON LABORATORIES REPORT 
TYPE ' C * 
Cases Showing Well-Marked Symptoms. 
The two following cases illustrate sub-group ' I ' of this type. Fatal cases 
showing no sleep symptoms. 
Case 82. Kimfuta. Female. Age eight. 
History, — Patient is a Lower Congo native, and comes from a village four hours' 
march from Leopoldville. When brought to Leopoldville three months back she 
was an orphan and destitute, and a fortnight ago was sent to hospital, more through 
lack of friends to look after her than because of any suspicion of sleeping sickness. 
December 29. General condition. Patient is miserably thin, and has the 
appearance of being half starved. She is very weak, her feet are full of chiggers, 
and she can only walk with difficulty. She lias a dazed expression, and is constantly 
trembling. Tremors are increased on the slightest exertion. 
Conjunctivae are congested and there is a slight purulent secretion. Intelligence 
is good, answers questions quickly and well. Skin, dry, imbricated, and filthy. 
Lymphatic glands, all easily palpable and hard, save femorals, which are much 
enlarged, soft, and matted together. The child complains of backache, and insists 
that she has sleeping sickness, but her condition is thought to be due mainly to 
starvation and ill-treatment. Circulatory system, normal. Respiratory system : 
slight bronchitis. Liver, normal. Spleen, just palpable. Alimentary system : 
tongue heavily coated, teeth tartrous, gums healthy, appetite excellent, abdomen flat 
and hard. Nervous system, reflexes all increased. 
January 8. In spite of attention, cleanliness, and better food, patient is going 
down hill. 
January 16. Greatly emaciated, tremors increased, patient can hardly stand and 
cannot walk, speech is thick but coherent. There is no drooping of lids, but eyes 
are fishy and vacant ; intelligence is now very dull ; she whines and complains on 
being disturbed ; eats little ; is seldom asleep, although she is always lying down, 
and passes faeces under her. 
January 19. Emaciation extreme, is too weak to rise, lies with wide-open 
mouth and eyes, whines, moans, or attempts to speak if touched. 
January 20. Spleen punctured, only a few parasites seen, although blood con- 
tained 100 to cover. Died during night. 
January 2 1 . 
Necropsy commenced at 7 a.m., nine hours after death. Bod}' much emaciated. No bed-sores, nor 
oedema. Ring-worm of scalp. Mouth foul, pyorrhoea alveolaris, teeth irregular, second dentition. 
Thorax: Pleurae normal. Diaphragm : Right side, fourth space ; left side, fifth rib. 
Lungs : Left lung normal ; right lung, old adhesions of upper and middle lobes. 
Pericardium contained 5 c.cm. of turbid yellow fluid, in which no trypanosomes were found. 
