45 
IX.— W. R. E., aged 46, was in the West Indies from 1881 to 
1903, exploring and planting. 
In 1903 he went to Northern Nigeria as a Forestry Officer. 
Although his duties took him all over the country and exposed him 
to much hardship, he enjoyed excellent health during his first tour 
of twenty months. After furlough in England he returned to 
Northern Nigeria in October, 1905, and kept perfectly well till 24th 
September, 1906. About the latter date he got an irregular fever 
which resisted quinine in full doses. Not improving he was invalided, 
and arrived in England on 29th November, 1906. He had slight 
fever on the voyage home, and at that time observed certain red 
patches on his skin, which he attributed to pressure from his clothes. 
After six weeks in the country, during which he took long walks and, 
with the exception of a slight fever at Christmas time, felt very well, 
he was sent to me officially for report. 
I saw him first on January 15th, 1907. On examination 1 found 
his trunk covered with rings and patches of erythema; several 
cervical, axillary and inguinal glands were enlarged though painless; 
spleen and liver were also slightly enlarged and his pulse was quick 
100. I found trypanosomes in his blood. There were no other 
symptoms of trypanosomiasis or of other disease. He said he felt 
fairly well. I sent him to hospital for treatment and obsen'ation. 
Atoxyl injections were begun on January 25th, 1907. They 
were given every second day, the dose being gradually raised to 
seven grains. He remained in hospital from January 21st till March 
4th, 1907. For the first fortnight temperature was somewhat erratic, 
ranging from 98° to 99® F,; once it was I00'8°. Subsequently, with 
the exception of one short rise of a few hours to ior8® on March 
5th, and attributed to a cold, temperature was steadily normal or 
subnormal Erythema and trypanosomes disappeared about 
February 12th. 
After leaving hospital he returned to his home in the country, 
where the injections were continued. About July symptoms of 
peripheral neuritis — not of a very pronounced character—showed 
themselves. He was again taken into hospital and a course of 
mercury substituted for the atoxyl. The gums were slightly 
‘ touched.’ The neuritis subsiding, the atoxyl was resumed in 
smaller doses. He now became so well that he wished to return to 
