TRYPANOSOMES, TRYPANOSOMIASIS, AND SLEEPING SICKNESS 
intelligence improved. During the winter he contracted several colds, but was otherwise well. 
Rheumatic pains in the knee, shoulder, and wrist joints were complained of, but quickly disappeared. 
Somnolence was never observed. Easily excited and naturally irritable. Outbreaks of passion occurred 
at times ; during such an outbreak he became frenzied and incapable of controlling himself. On one 
occasion severe frontal and occipital pains were complained of. At the same time it was noticed that the 
parasites were then starting to increase in number. The temperature also rose, but after two days the 
trypanosomes lessened in number, and coincident with this the headache disappeared and the temperature 
began to fall. A trial of subcutaneous injections of arsenic having proved too painful, liquor arsenicalis 
was given, but he quickly complained of headache and nausea. A varied treatment of Blaud's pill with 
arsenic, alternating with a mix vomica tonic and then liq. fowleri alone, was given. The blood counts 
still further improved ; the parasites became scantier, and were often absent from the peripheral blood. 
The temperature, which at this time was irregular and sub-normal, became more regular, though very 
often sub-normal. Owing to his illtemper and homesickness he was sent back to the Congo in August, 
and the missionary authorities were given a supply of trypanroth tabloids for him. No news 1 has been 
received as to the bov's progress. Lumbar puncture was performed several times, but no parasites were 
found in the cerebro-spinal fluid, nor was such fluid infective to animals. The fluid possessed the normal 
characters ; it did not agglutinate trypanosomes. 
Blister fluid : Serum obtained from a small blister proved negative on two occasions. Mice 
inoculated with it, failed to become infected.. Under the chapter headed Periodicity, tables shewing the 
presence and absence of the parasite in the blood are given. During the last twenty-two days, the parasites 
were hardly ever present, and were absent for the last eleven days before he left England, apparently due 
to the arsenical treatment. 
Differential Count 
March 4 
June 15 
Polymorphonuclear neutrophile ... 
5 3-98 
61 -8 1 
Large mononuclears 
678 
5-63 
Lymphocytes 
10-32 
8-36 
Eosinophiles 
25-69 
20-91 
Mast cells 
o-68 
o + 8 
Transitional 
2-55 
2-81 
iocroo 
ioo-oo 
Banja. Male. Aet. 26. 
Under observation from January 18 to April 1, 1904. Arrived in England, May 22, 1904. The 
early history of the case has been recorded. 
Physical condition : A large, strong, very obese man. Intelligence poor. Skin soft. General enlarge- 
ment of the glands. Spleen just palpable, not tender. Liver not enlarged. Urine, sp. gr. 1018, no 
albumen, no sugar, no bilirubin. 
1. On May 18, 1905, n;ws was received that this patient was, in the middle of April last, in the last stage of Congo 
sleeping sickness. ' He was not always sleeping, but greatly emaciated, talks rubbish, anil seems to have lost his reason.' 
Further details not yet to hand, July 20, 1905. — H. E. Annett. Aug. 30, 1905, patient dead. — J.L.T. 
