10 
THOMPSON YATES AND JOHNSTON LABORATORIES REPORT 
normal ; urine normal in quantity, sp. gr. 1032, no albumen, no chlorides ; liver 
slightly enlarged, but not tender ; spleen normal in size ; considerable tenderness 
over the splenic urea.' 
The patient remained in hospital for fourteen days, during which period the follow- 
ing further observations were noted : — The temperature curve* shewed three short 
periods of pyrexia, during which the temperature reached 101 0 to 102 0 F. in a few 
hours, and fell rapidly to normal, with intervals of about three days apyrexia. On one 
occasion the spleen was felt below the costal margin. The pulse and respiration were 
always frequent, and varied on exertion and with temperature. Generally, however^ 
their rates were quicker than when in hospital at Bathurst. No malarial parasites 
were found in specimens of his blood during this time. 
The patient remained in England recruiting his health for some months, and 
returned to Bathurst in December, 1901. On the voyage out he was very ill with 
what was diagnosed as pneumonia of an atypical character. The sputum was 
described by the ship's medical officerj" as more of the nature of pure blood. 
Immediately on his return to the Gambia, K. was placed on the sick list. He 
had not yet recovered from his attack on board ship, and was very thin and weak, 
and easily fatigued. On examination by Dr. Forde and Dr. Dutton, on December 
18, his temperature was [00*4° F. ; pulse, 96, respirations, 34. 
' His chief symptoms were weakness, marked loss of weight, inability to walk 
far without feeling very tired Patient did not complain of any definite symptoms. There 
was no pain nor headache, but a little loss of appetite, and sleeplessness at times. On 
December 16 he had slight bleeding from the nose. There was no cough, but some 
dyspnoea on exertion. The general facial aspect, which had been remarked upon by 
his friends, was very striking. The face was puffy and congested. The eyes were 
sunken, the conjunctivae had a watery appearance, but were not congested ; the most 
prominent feature was the puffiness of the lower lids, which were distinctly oedematous. 
On examining the body generally, one noticed that the skin appeared cyanotic, 
especially 011 the chest and thighs ; pressure made with the hand caused a white mark 
which took some little time to disappear. There was some puffiness around the 
ankles, the skin pitting slightly on pressure ; the skin was dry ; no jaundice. 
No cough, no expectoration. Respirations were increased in frequency. This 
frequency of the rhythm was very noticeable on the slightest exertion or excitement. 
During the time of these observations, his respirations were never below 
10 per minute, the usual being from 25 to 30 ; they were never laboured. Chest 
somewhat barrel-shaped ; breath sounds, normal ; no dulness ; slight emphysema, 
otherwise the lungs seemed healthy. Pulse frequent, 96 ; regular in time and force ; 
tension, normal ; artery, normal. The pulse was always frequent and hardly ever 
* The chart and details of the case are given in a ' Preliminaty note upon a case of a Trypanosome occurring in the 
blood of man.' I. Everett Dutton. Thompson fates L.lboratory Report^ 1902, Vol. IV, Part ii. 
f British Medical Journal, 1903, March 28. 
