TRYPANOSOMIASIS EXPEDITION TO THE CONGO 
97 
April 30. Physical examination repeated, no change observed. 
May 7. Patient drew attention to a redness on chest which he said was very 
obvious last night. On examination, red diffuse areas seen under nipple and on 
epigastrium, not itchy or painful ; one annular area about 5 cm. in diameter on right 
lower costal margin, had slightly swollen periphery with injected vessels, while the 
centre remained uncoloured. Five diffuse injected areas, varying in diameter from 2 to 
4 cm., were seen on back. 
May 8. Says that temperature rose to 104 0 F. at about twelve last night. To- 
day there is marked oval ring of taint, slightly raised erythema, measuring 1 by 5 cm. 
just above the right eye ; it is not tender or itchy, and the skin is distinctly thickened. 
The ring seen yesterday on right hypochondrium still persists, its capillaries are 
injected, and its general appearance is much the same as yesterday, its centre is 
yellowish ; there is no extravasation of blood (glass slide test) in either of these 
annular areas. On left hypochondrium were more or less blotchy areas of redness, 
mixed with very faint greenish or yellowish discolouration. 
Patient has more colour and looks better than when he was first seen, he has more 
appetite and savs that he feels stronger and does not become so easily fatigued as when 
he first came to Leopoldville. 
May 9. The ring of erythema over right eye has almost entirely disappeared, 
the blotchy areas on body are vanishing. Although patient's temperature has been 
about I03°F. tor the past two days, he says that he has felt no inconvenience from it. 
His appetite has been good, and he walked about as usual. 
May 10. Patient leaves Leopoldville, invalided home. The remains of ringed 
erythema are seen on chest. Malarial parasites were not seen in this case. 
The first attack ot fever occurred within six weeks ot this man's arrival in Congo. 
He spent approximately the first week in the Free State in Boma, and then went as 
directly as possible to his station. In twenty-seven days after reaching the wood-post 
his illness commenced. It does not seem at all probable that he acquired his infection 
so long ago as 1898 when he was on the Gold Coast, nor do we believe that he became 
infected either at Boma or while travelling by train to Leopoldville. We are inclined 
to think that he became infected with trypanosomes after his arrival at his post. It, 
therefore, seems probable that the 'incubation period,' between the time of infection 
with Trypanosoma gambiense and the appearance of the symptoms associated with human 
trypanosomiasis, may be so short as four weeks. 
It is extremely interesting to note in this connexion that Glossinae were extremely 
numerous at this post, situated on the river bank, and were a most disagreeable and 
constant pest. 
o 
