TRYPANOSOMIASIS EXPEDITION TO THE CONGO 33 
March 4. Patient dying, but perfectly conscious, even acutely observant of all 
that goes on around her. Died at 2.30 p.m. 
Necropsy commenced one-and-a-half hours after death. 
Bod}' warm, wasted though not distinctly thin. Rigor mortis just commencing, pupils evenly and 
widely dilated. Tissues dry, panniculus fairly abundant. Muscles normal. 
Thorax : Pleurae normal. 
Pericardium contained a few drops of fluid. 
Heart : weight, 148 grammes, small, muscles pale and firm. Mitral valve showed distinct, reddish, 
gelatinoid thickening. 
Lungs: Weight, right, 300 grammes; left, 223 grammes. There was slight bronchitis of both 
lungs and marked hypostatic congestion, the latter condition marked in the right ; vessels contain firm, 
stratified clots. 
Abdomen : Pelvic peritoneum congested and genitals firmly bound down by extensive fibrous adhesions. 
Liver and spleen adherent slightly by old fibrous adhesions to adjoining organs and parietes. 
Liver : Weight, I, 582 grammes, slightly nutmeg. Gall bladder moderately filled with golden bile. 
Spleen: Weight, 221 grammes, 17-9 5 cm., upper lobe almost entirely divided by deep indentation 
from lower, substance dark, firm, friable. 
Kidneys : Weight together, 218 grammes, normal. 
Pancreas and suprarenals : Normal. 
Alimentary Canal : Normal. 
Bladder : Normal. 
Genitals : Uterus small, non-parous, metritis with acute intense cervicitis ; fallopian tubes and 
ovaries bound down to uterus by old adhesions, acute vaginitis. 
Bone marrow (femur) : Reddish brown. 
Brain : Superficial vessels congested, particularly over posterior half of hemispheres (patient lying on 
back for several days before death). Relatively small amount, though increased, of sub-arachnoid fluid ; 
no ependymal haemorrhages; about 30 c. cm. cerebro-spinal fluid escaped on cutting tentorium. Cranial 
bone sinuses normal. 
Lymphatic glands : Retro-peritoneal and pelvic glands were enlarged ; the latter group being congested ; 
the remaining groups of glands were normal. 
In this attempt to illustrate the course of sleeping sickness, as found in the 
Congo, we have tried, as far as possible, to exclude from the illustrative cases those 
in which obvious secondary lesions were demonstrated posl-mortem . It will be seen 
that deep sleep, continued sleep and lethargy, symptoms described as characteristic of 
sleeping sickness, are not features of the Congo disease as observed by us up to the 
present. 
Trypanosoma Gambiense as a Probable Cause of Congo (Sleeping) Sickness 
(A) As already indicated, in nearly every case in which sleeping sickness was 
diagnosed, or suspected, trypanosomes have been found in either blood, 
cerebro-spinal fluid, or both. 
(/?) We have shown that there is a very evident clinical connexion between 
those cases which have only very slight symptoms ('Trypanosoma fever') 
and the advanced cases of 'sleeping sickness' seen in hospital. 
F 
