28 THOMPSON YATES AND JOHNSTON LABORATORIES REPORT 
Spleen : Weight, 345 grammes ; measures 22 x 10x4/5 cm. ; substance firm, slightly fibroid. 
Kidneys : Weight together, 338 grammes, normal. 
Genitals, with exception of chronic vaginitis, normal. Mouth foul with sores. Intestines contained 
a few anchylostomes and Trichocephalus dispar. Alimentary canal otherwise normal. 
Brain : Vessels all much congested, sub-arachnoid fluid increased and turbid. Microscopically 
cerebro-spinal fluid showed pus cells but no trypanosomes. 
Lymphatic glands all much enlarged. Retro-sternal and mesenteric glands slightly injected. 
Decomposition had commenced in retro-peritoneal glands. Femoral and inguinal glands congested and 
in one or two of the latter pus formation had commenced. 
The two following cases, not easily classable under the foregoing headings, are, 
we think, of interest, as they illustrate the extremely rapid course the disease occasionally 
takes after symptoms have once developed. 
Case 69. Kabali. Female. Age twenty-six. 
History. — Patient comes from the Kasai district, and left her native village, which 
is four days distant from Lusambo, ten years ago. Since then she has been in many 
places along the Upper Congo. Has lived in Leopoldville for the last two or three 
years. 
When first seen on December 7, 1903, she stated that her illness had commenced 
four months previously, and began with rigor and fever ; the left side of her head 
swelled and was painful. There was no sore nor evacuation of pus. This condition 
lasted for six weeks. She says that she has since become thinner and weaker, 
particularly during the past two or three weeks. She has lost her appetite and has a 
tendency to diarrhoea. 
December 25, 1903. General condition. Patient is a tall, well-developed woman, 
but thin, and her muscles are flabby. She is less active and vivacious than when first 
seen, and has a tired, listless gait. Her expression is rather dull, but she is intelligent 
and answers questions quickly and well. She speaks without hesitation or thickness. 
Complains of pain on pressure on shins. Skin is very abnormal. It is clean, though 
dry, and gives a rough feeling to the touch. This is most marked on shoulders, arms, 
and extensor surfaces of thighs and legs. In the parts most affected the skin has 
somewhat the appearance of an early exfoliative dermatitis, in which patches of glazed 
and thinned skin desquamate, slightly, at their edges along rectangular cracks and 
furrows. There is no itching nor discomfort, and the condition seems to be recent. 
At some spots are areas of crumpled tissue-paper-like wrinkles. No oedema. 
Lymphatic glands all enlarged. Tongue furred, moist, and steady. Circulatory 
system, pulmonary second sound is very much accentuated. Respiratory system 
normal. Liver normal. Spleen, considerably enlarged. Nervous system, co-ordination 
and muscular sense, normal ; reflexes, normal ; pupils react to accommodation and 
light, mental condition, alert. 
January 18. Patient was admitted to hospital two days ago as a case of sleeping 
sickness. She is much thinner and weaker. Expression dull and sleepy. Skin 
