TRYPANOSOMIASIS EXPEDITION TO THE CONGO 
25 
first seen on November 23, patient was a thin, sharp-witted lad, and denied that he 
had sleeping sickness, but was said by his companions to sleep a great deal. 
December ir, 1903. General condition. He is a weak emaciated boy; intelli- 
gence good ; answers questions quickly ; no thickness of speech ; no unsteadiness of 
gait; is a mouth breather, and his ' adenoid look ' gives him a certain vacancy of 
expression. Skin is dry and scurfy and covered with early ' craw-craw.' Muscles 
wasted ; mucous membranes anaemic ; lymphatic glands all enlarged. Circulatory 
system, normal. Respiratory system, slight bronchitis. Alimentary system, tongue 
steady, slightly coated, teeth and gums covered with tartar. Liver, 1 cm. below ribs. 
Spleen, 2*5 c.cm. below ribs, not tender nor painful. Nervous system, reflexes normal ; 
pupils react to accommodation and light ; co-ordination and muscular sense, normal. 
December 28. Patient still answers questions quickly and well, has no pain nor 
headache, complains of a constant desire to sleep, but is seldom seen sleeping. Heart : 
reduplication of first apical sound. No oedema. Ocular tension is very distinctly 
increased, and the eyes are prominent. Knee jerks exaggerated, tendon reflexes not 
obtainable. He is able to go some distance from the hospital to collect firewood to 
cook his food. His inordinate appetite has become the joke of the hospital. 
January 19. Patient now sleeps most of the clay, or sits dozing over his fire 
with his head drawn back and his mouth wide open. 
January 21. Is too weak to walk about, but lies in the hut complaining and 
talking of his weakness. 
January 25. Sleeps much more than previously and is becoming, if possible, 
more emaciated. Is easily roused when touched. 
February 2. Is vivacious and talkative again. When lying down or dozing over 
fire, head is drawn back and chin protruded to utmost as noted on January 19. 
February 5. Is much worse again, apparently dying, lies curled up on his side, 
and is roused with difficulty. 
February 8. Dying, almost pulseless, Cheyne-Stokes respiration, lies on back in 
an extreme state of opisthotonos, with legs extended and head drawn back to such an 
extent that two fists, one above the other, can be passed beneath him. Died at 7 
p.m. 
Necropsy commenced one-and-a-quarter hours after death. Bod}' much emaciated, still warm. 
Slight oedema of forehead, shins, and dorsa of feet. 
Thorax : Pleural cavities normal. Pericardium contains 100 c.cm. of clear yellow fluid in which were 
seen divisional forms of trypanosomes. 
Heart : Weight, 226 grammes, normal. 
Lungs normal. 
Abdomen : No fluid, old firm fibrous adhesions of right lobe of liver to parietes. 
Liver : Weight, 610 grammes, slightly congested, otherwise normal. Gall bladder full of dark thick 
bile. Ducts patent. 
Kidneys : Right showed marked peri-pyramidal congestion. 
Spken : Weight, 266 grammes. Slightly enlarged, substance firm, not slate}-. 
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