TRYPANOSOMES, TRYPANOSOMIASIS, AND SLEEPING SICKNESS 3 
7.30 p.m. : Unconscious most of day. At times seemed to hear when spoken to, hut most of the 
time no response. Bowels moved from enema 2.30 p.m. and acted several times since. Croton oil, 
mid-dav. Just had two general convulsions, lasting about three minutes each. Last fit, head and eyes 
first to left, afterwards to right. Arms and legs worked too. (Whilst writing a third fit came on). 
Conjunctivae much injected, good deal of mucopurulent discharge. 
June 1 1, midnight : Semi-comatose during last twenty-four hours. No fits ; takes milk and whiskey 
when given. Corneal reflex present. Winced slightly when needle pierced skin for lumbar puncture 
to-day. No fluid ran out, a little drawn out by syringe, but mixed with blood. Profuse sweating on 
face, forehead, and neck. Past forty-eight hours, not much sweating on trunk. Pulse, 145, full, low- 
tension. Respiration, 32 ; urine and faeces passed involuntarily. 
June 12, 6.45 p.m. : Temperature getting higher all da}- and now I05'6. Pulse, 200, small volume, 
poor tension. Head and neck sweating still, trunk not. Respiration, 48 ; alae nasi working ; Cheyne- 
Stokes in type at times. Not been able to swallow fluid food to-day. 
7.30 p.m. : T. 107-4 (thermometer seen). 
7,45 p.m. : In extremis ; face covered with cold perspiration. Corneal and knee jerk reflexes gone. 
T. io5 - 8. Heart beats 168 at apex, ever}' third or fourth only reaching wrist. Respiration, 24, jerky 
(chin could be made to touch sternum). 
7.55 : Respiration, 8 per min. Heart, 56. Violent last inspiration. Heart and respiration failed 
together. No P.M. rise ot temperature, but fall (see chart). 
For autopsy and morbid anatomy see Part II, Kitambo. 
Tomi. Aet 18. Male. 
He had been employed as cook to the Rev. Mr. Gordon at the Kinshasa Mission of the Baptist 
Missionary Society, Stanley Pool. As he was only seen a couple of times by the members of the Expedition, 
no detailed history is procurable, Mr. Gordon first noticed the boy to be careless, disinterested, and 
quarrelsome in December, 1903. In January, 1904, he complained of pains in one eye, which became 
inflamed. It improved for a time, but by the end of February both eyes were affected. This, coupled 
with the increasing irritableness and his being found sleeping at odd times in the cook house caused the 
missionaries to fear he had ' manimba.'i In April he was examined by Dr. Dutton, and parasites found. 
On his arrival at Southampton, May 22, he was able to walk, but was extremely nervous and 
hysterical, laughing and crying without cause. Marked tremor of the upper and lower limbs when in a 
sitting or recumbent posture was observed. This condition was accentuated if the boy noticed anyone 
looking at him. On his arrival in Liverpool, May 24, he was very excited, and homesick, but became 
quiet on being given light work to do. 
General Condition : A rather emaciated averaged-sized boy. Muscular development poor. Skin soft 
and clean— chiggers in both feet. Glandular enlargement general but not so marked as in other cases. 
Gait unsteady and very irregular, this is due to the chiggers. On standing still with the eyes closed he 
remains motionless for a few minutes and then starts to sway ; power over the knees suddenly appears to be 
lost and he will fall ; he can stand motionless if allowed to keep his eyes open, but after a while sways 
from weakness. At times, if seated, a violent tremor commences in the lower limbs, and heels rap the 
floor ; the knees, especially if the toes are resting on the floor, shake sideways and a little forwards. The 
hands and arms ma}- remain quiet or start twitching spasmodically. The head usually moves sideways, 
the lips tremble, the eyelids twitch and the eyes roll. Plaintive sounds are emitted but no coherent 
words. These symptoms may cease after a few minutes, or a crying fit terminate the attack. If spoken 
to he can usually rise and appear quite well again, at other times, the trembling, etc., is not interrupted 
and the general vacant expression continues. Much is due to hysteria. If taken into a dark room and 
1. A native name for ' sleeping sickness.' 
