THOMPSON YATES AND JOHNSTON LABORATORIES REPORT 
and said he had lost weight. He also complained of weakness of the legs. He had 
had occasional bleeding from the nose, and had noted some swelling about the ankles. 
The eyelids and nose were swollen and oedematous. Appetite fairly good. Some 
tendency to constipation. Respiration became troublesome and distressing on slight 
exertion. 
On examination, the most noticeable feature was the presence of the erythema- 
tous-looking, raised rash, on the skin ot the chest and back, thighs, and arms. There 
was marked dyspnoea. Pulse, 120, regular, poor tension. Respirations, 30. 
Heart slightly dilated. Urine, 1,016, acid ; no sugar ; slight trace of albumen ; of 
normal quantity. Patient's weight, 1 j8 pounds. Examination of blood : Sp. Gr., 
1,057 ; red corpuscles, 4,400,000 ; white, 6,800. Haemoglobin, 90 per cent. 
Temperature varied only between 97° and roo J F. From one to three parasites 
could be detected in every cover-glass preparation of blood taken from the finger. It 
was noticed that tissue juice obtained from the swollen oedematous lower eye-lid, 
or from the raised erythematous patches contained a comparatively larger number of 
trypanosomes than the peripheral blood. 
Up to December 29, the case continued to follow the chronic course, which 
apparently characterizes the disease in Europeans. The increased frequency of 
pulse and respiration, the peculiar congested areas of the skin, the local and fugitive 
oedemata, the enlargement ot the spleen, and the irregular rises of temperature con- 
tinued until the end. But under treatment, which, after the apparently useless 
administration ot quinine and arsenic in large doses, consisted of the admininistra- 
tion of urotropin in doses increasing from five to ten grains three times a day, the 
patient increased in weight (from 158 pounds to 168 pounds), and improved con- 
siderably in muscular strength. Slight rises of temperature, reaching sometimes 
102 0 F.j at intervals of from one to ten weeks, lasting only a few hours, and 
occasionally some increased difficulty in breathing produced some distress. 
The patient was usually in fairly good spirits, although having some idea of 
the nature of his condition ; but on rare occasions he manifested very considerable 
depression and indifference to living. There was always a tendency to constipation, 
corrected by regular use of aperient waters ; and short, smart attacks ot severe pain 
over the spleen at times caused him to remain indoors. Otherwise during this 
time he lived much in the open air, and practised the most regular and healthy 
habits. 
During this time parasites were very scanty in the peripheral blood, and at 
some examinations appeared to be entirely absent, at others two or three only could 
be discovered after a long examination of several blood films. But the inoculation 
of animals (white rats and monkeys) demonstrated their presence. 
On the morning of December 29, acute symptoms developed, ushered 
in by an indefinite rigor, the temperature being stated to be 99'6° F. In the 
