H THOMPSON YATES AND JOHNSTON LABORATORIES REPORT 
was lost gradually. Six months previously he had weighed one 
hundred and seventy-four, and two months before one hundred and 
sixty pounds. 
(2) He complained of constant accesses of intermittent slight fever 
(going up to 101 0 F.), which was not checked by quinine. He 
habitually used a clinical thermometer and took ten grains of quinine 
every two days ; so this history of fever may be assumed to be 
correct. 
(3) He became easily fatigued. He lost breath easily. His legs seemed 
sometimes to be weak, and he occasionally had palpitation. 
(4) He hail, from time to time, pain in his loins, particularly after 
exertion, and, twelve months previously, in the splenic region. 
He attributed the commencement of his illness to the bite of some insect 
which he received on his thigh, a year before (October, 1901), while at closet 
in Bathurst. This bite became livid and tender, and swelled up in a very short 
space of time to the size of a walnut. It was followed six hours later by an 
attack of 'ague,' which developed into 'fever ' and kept him in bed for some days. 
Since this illness he has never been himself. 
Clinical Examination. — In October, 1902, he had all the general appearances 
of a healthy man- — his figure was rotund, his face was not emaciated, and he certainly 
did not look like a man who had lost forty-two pounds during the preceding year. 
His friends, however, told us that he had lost a great deal of flesh and was much 
less stout than he formerly was. The exposed parts of his body were darkened from 
exposure, although his trunk, which was much marked by recent insect bites, was 
quite white. His legs were deeply scarred and pigmented by former ' bush boils and 
ulcers.' The blotchy erythemata seen' 5 ' 5 °' 49 in the first European cases were not 
present, but vasomotor reaction was easily excited and his skin was markedly dermato- 
graphic. Although persistent reddening of the skin was noticed 111 places pressed 
upon by clothing, as, tor example, around the waist and on the chest, we never 
observed any of that doughiness of the skin or the local transitory maculae which 
have been such marked characteristics of the other European cases. 
Slight pitting on pressure was observed on the shins and ankles. Mr. Q. 
was very certain that there had never been any puffiness of his evelids. 
No organic lesion of heart or lungs was detected, although the rapidity' of 
both pulse and respiration during rest was increased. There was no history of 
haemorrhages. His appetite was good and his bowels regular. The liver extended 
2 cm. below the costal margin but was not tender. The spleen extended 3*5 cm. 
below the costal margin and was rather tender on firm pressure. 
