96 THOMPSON YATES AND JOHNSTON LABORATORIES REPORT 
The fifth fever commenced March 17, and lasted eleven days, ending on March 
27 ; temperature, 104° F. to 105 - 8°F. 
The patient stated that the second, third, and fourth ' fevers ' came on suddenly 
and without any premonitory signs ; tor instance, while sitting at dinner he found 
himself in a high fever without any shivering fit or other prodrome. Before the first 
and fifth fevers, on the other hand, there was definite malaise, but no rigors. 
From March 2 to April 10 he was alternately in bed and sitting in his chair ; on 
March 31 and April 1 and 5 his temperature was raised. 
During these fevers and until his arrival in Leopoldville, April 13, he took 
about a gramme of quinine daily. 
During the last fever he was greatly troubled by daily vomiting, which did not 
occur, however, unless something had been ingested. 
The patient's friends say that he has lost flesh. 
Physical examination. — April 18, 1904. Present condition: Man of average 
height and build ; distinctly sallow and anaemic appearance ; slight blepharitis (old- 
standing), complains of weakness ; says ' knees are weak ; ' loses breath quickly. 
Skin : Has a doughy feel, and is distinctly oedematous, this is most marked 
over ankles, where there is pitting ; there is no erythemata or other eruption; derma- 
tography not marked. 
Lymphatic glands : Palpable, not enlarged. 
Circulatory system : Heart, action rapid ; dulness, normal ; difference between first 
and second sounds, less marked than normal ; no bruits ; pulse, frequent, regular in 
time and volume ; artery, normal. 
Respiratory system : Normal ; no complaint. 
Digestive system : Bowels constipated, goes two to three days without movement ; 
tongue, flabby, not much furred, no tremor ; throat, normal ; appetite, fair. 
Liver : Not enlarged (width in nipple line 6 cm.), a suspicion of tenderness. 
Spleen : Just palpable ; slight tenderness. 
Nervous system: Sensation to pain, touch, heat, cold, and distance apart of pin 
points, normal ; superficial reflexes, normal,; knee jerk, slightly increased. 
Eyes : Left eye is seen by ophthalmoscopic examination to have a markedly con- 
gested disc, there is deep cupping ; choroidal vessels show very plainly. 
Urine. April 29. Twenty-tour hours specimen (preserved with thymol), volume, 
660 c.cm., dark sherry color, acid ; urea, about 3 grammes to 100 c.cra. urine ; 
spectrum of urobilin, marked. 
May 4. Twenty-four hours specimen ; volume, 1,075 c. cms., dark-brown sherry 
color ; acid, no albumen ; Sp.Gr. 1,016 (temperature, 79 0 F.) ; urea, 2*6 grammes to 
100 c.cm. urine. 
May 10. Twenty-four hours specimen ; volume, 700 c.cm. ; dark color ; 
Sp.Gr. 1,027 (temperature, 78 - 8° F.) ; acid, no deposit ; no blood or albumen ; urea, 
2*6 grammes to 100 c.cms. urine. 
