TRYPANOSOMIASIS EXPEDITION TO THE CONGO 31 
Brain : dura easily detached, sub arachnoid apace filled anteriorly with thick-funned lymph, 
posteriorly sub-arachnoid fluid very cloud}- and semi-purulent ; all vessels moderately congested. About 
50 c.cm. turbid yellowish cerebro-spmal fluid escaped on opening tentorium. Cranial bone sinuses 
normal. 
Bone marrow (femur) : Very dark and diffluent, like clotted blood. 
Lymphatic glands : All retro-peritoneal and pelvic glands very deeply congested ; on section, soft, 
with a good deal of blood}- fluid. One or two omental glands in a similar condition. 
Glands from the other parts of the bod} enlarged but otherwise normal. Trypanosomas were not 
found by coverslip preparations in any of the body fluids or blood. 
Case 86. Yaiyai. Female. Age twenty. 
History. — Patient was sent to us on January 7 by native dispenser at a settlement 
near Leopoldville. She was said to have recently come from a district in which 
sleeping sickness was present. She was supposed to he in the 'initial stage' of that 
disease. Patient was well dressed, clean, and neat. She seemed in good health. She 
had, however, a peculiar vacancy of expression, and answered questions in an excitable 
and voluble manner, making grimaces. She stated that she had sleeping sickness, but, 
as yet, not badly. Patient was kept under observation tor two days, but nothing- 
abnormal was noted, save her expression and some display of irritability. 
On January 24, she was carried into hospital in a listless, dazed, and sleepy 
condition, unable to walk, and apparently unable to speak. 
February 4- General condition : Is a well-nourished woman ; expression dull 
and vacant ; manner apathetic and listless. Is able to walk with slow shurrling steps. 
Intelligence much dulled. Tongue coated and moist, slight tremors. Skin normal. 
Glands all enlarged save posterior cervical. Considerable oedema of shins and insteps ; 
lips and eyelids puffy. A[ petite good. Patient munches her food in a slow way, 
peculiar to many advanced cases. She frowns continuously. Circulatory, respiratory, 
and alimentary systems normal. 
February 10. Sleeps a good deal but is much better than she was, is not so 
apathetic, and cat: talk and laugh while eating ; appetite good. 
February 16. Vacancy of face is again marked ; patient is very weak and trembles 
all over ; she speaks in weak voice only after much persuasion. 
February 28. Since last note patient's condition has not altered. She has been 
unable to get off her bed ; passes motions into bed ; has only been able to take 
liquid food, and that only with assistance, is usually wide awake and conscious of all 
her surroundings, and, until now, has shown no very marked signs of wasting. To- 
day temperature, i<02 - 4 P., profuse perspiration ; crepitation and dullness at base of 
right lung. 
March 3. Is now helpless, with sunken eyes and haggard face ; body and 
limbs show marked wasting ; oedema of shins and insteps and puffiness of face have 
disappeared ; tremors, which were very marked, have ceased ; she cannot take even 
soup ; large bed-sores have formed on either side of sacrum. 
