TRYPANOSOMIASIS EXPEDITION TO THE CONGO 23 
December 24. Patient in same state, helpless hut conscious. Died during the 
morning. 
Necropsy commenced one-and-a-quarter hours aftei death. Rigor mortis just commencing. Body 
thin, muscles wasted, eyes prominent, both pupils dilated (especially right). Oedema of shins, feet, and 
forehead. Marked cutaneous thickening of eyelids. Many chiggers in feet. Tongue bitten through, 
clenched between teeth (no history of a lit). Body very warm ; had been lying in sun, skin blistered. 
Panniculus scanty. 
Thorax : Right pleura, few fibrous adhesions at base of lung. Left pleura, showed three small sub- 
pleural haemorrhages along vertebral column at level of fifth dorsal vertebra. 
Pericardium contained 100 c.cm. clear yellow fluid. 
Heart: Weight, 34.1 grammes ; fat, oedematous, valves normal, muscle pale, patchy thickening of 
endocardium of left ventricle, vessels normal. 
Lungs : Slight bronchitis, oedematous. Weight : Right lung, 226 grammes ; left, 454. grammes. 
Abdomen : Peritoneal cavity contained about 2 c.cm. clear fluid. Colon at level of umbilicus ; all 
abdominal blood-vessels turgid ; very extensive old fibrous pelvic adhesions ; several small broad ligament 
cysts full of clear fluid ; firm fibrous adhesions of liver and spleen to parietes. 
Liver : Weight, 1,818 grammes : distinctly fatty, capsule over surface thickened. Gall bladder full 
of dark green fluid bile, ducts patent. Between liver and diaphragm was a layer, 5 c.cm. thick, of 
colourless gelatinous oedema. 
Spleen : Enlarged and gorged with blood, substance soft and friable. 
Kidneys, together, weighed 250 grammes, both showed cloudy change, capsules were adherent, and 
there was congestion of venae stellatae and around pyramids. 
Pancreas and suprarenals normal. 
Alimentary system : Mouth foul, gums soft, stomach normal, intestines normal, anchylostomes in 
jej unum. 
Genitals : Vagina, slight mucous and cellular discharge, containing Trichomonas vaginalis and various 
bacteria ; no acute inflammation. Uterus nonparous, sub-acute metritis. Left ovary partially fibroid. 
Right ovary normal; no signs of recent inflammation in tubes. 
Bone marrow (femur) : Very dark reddish orange. 
Brain : Dura not adherent ; superficial vessels congested, but not so much as in many of the 
cases ; sub-arachnoid fluid not greatly increased and only slightly turbid ; ventricles contained a few 
c.cm. of yellowish, slightly turbid fluid, ependymal vessels congested ; no haemorrhages seen ; spinal 
cord vessels turgid. 
Lymphatic glands were nearly all enlarged, watery, and often congested. Some or pelvic and lumbar 
glands were chocolate colour and almost diffluent ; a small gland size of pea in much the same condition, 
but not diffluent, was found lying on head of pancreas. No actual haemorrhages into gland substance 
were seen. Fluids from pericardium, glands, receptaculum chyli, and oedematous tissues were examined, 
but no trypanosomes were found. 
The following cases illustrate suh-group ' 2 ' of Type ' CV Fatal cases showing 
sleep symptoms. 
Case 62. Jeri. Male. Age eleven. 
History. — Is a native of Irebu, a town near Lake Tumha, where sleeping sickness 
is said to be present. Left his village two years ago and has since lived in or near 
Leopoldville. He has been in hospital tor one-and-a-quarter months. Was 'boy' to a 
white man who sent him to hospital as a suspected case of sleeping sickness. When 
