TRYPANOSOMIASIS EXPEDITION TO SENEGAMBIA 
less than 90, even when the temperature remained low. Heart apex in fourth 
interspace, four inches from the middle line ; impulse distinctly seen, not diffuse ; 
cardiac dulness commenced about at the third rib and did not extend to the right 
beyond the midsternal line ; cardiac sounds, normal, no adventitious sounds. 
Appetite fair, no diarrhoea ; had to take an occasional aperient. No pain on 
abdominal palpation. Liver dulness, four-and-a-half inches in nipple line, extended 
just below costal margin. Slight bulging over the splenic area ; dulness increased 
diagonally, measured seven inches ; the edge of the spleen could be telt below the 
costal margin ; no tenderness 011 palpation. In nervous system no'ching abnormal 
could be detected. No definite enlargement of lymphatic glands. Urine normal in 
quantity, rather high-coloured ; Sp. Gr., 1,020 acid ; no albumen ; no casts ; some 
phosphates.' 
During the next few weeks, while the patient was still on the sick list, observation 
of his condition shewed a temperature, pulse, and respiration similar to what had 
previously been recorded in England. The temperature chart showed periods of slight 
pyrexia lasting three or four days, with intervals of four or five days in which the 
temperature remained below normal. During this time K. was never confined to his 
bed, and was able to take short walks ; his appetite was distinctly good during the 
apyrexial periods, and the pain over the spleen disappeared. 
On December 26, he was sent to Cape St. Mary, seven miles from Bathurs", 
on the sea coast, and here he quickly improved. He still, however, shewed a slight 
temperature nearly ioo°F. at times, some pufHness about the eyes; slight injec- 
tion ot the conjunctivae ; some weakness in legs ; and slight oedema about the 
ankles. He was able to resume his ordinary duties, seeming to be much 
improved. 
It was during this period that the true nature ot the blood parasite was made 
out by Dr. Dutton, and it was noted that during the pyrexial accesses the parasites 
were more numerous in the blood than during the apyrexial intervals, when occa- 
sionally none could be found during an ordinary examination. 
'A blood count on December 18 (tour hours after food) shewed red 
corpuscles, 3,850,000; white corpuscles, 12,000 per c.cm. ; haemoglobin (Gower's 
apparatus), 76 per cent. A differential count ot the white corpuscles made 
on several occasions, both when parasites were present and absent from the peripheral 
blood, shewed an increase of lymphocytes at the expense of the polynuclear cells, the 
relation being generally about fifty per cent, of the latter to forty per cent, of the 
former.' 
On July 25, 1902, K. again arrived in England, invalided home from Bathurst. 
The chief points of his condition, taken from notes made at the time by Dr. Dutton, 
were : — Although the temperature and pulse had not been regularly taken, K. described 
short periods of fever and of feeling out of sorts. He looked considerably thinner, 
