implication of the motor centres.*[1] By this time the patient has taken to bed, or he lies about in a corner of his hut, indifferent to everything going on around him, but still able to speak and take food if brought to him. He never spontaneously engages in conversation or even asks for food. As torpor deepens he forgets even to chew his food, falling asleep perhaps in the act of conveying it to his mouth, or with the half-masticated bolus still in his cheek. Nevertheless, such food as he can be got to take is digested and assimilated. Consequently, if he is properly nursed, at this stage there may be no general wasting. As time goes on he begins to lose flesh, tremor of hands and tongue becomes more marked, and convulsive or choreic movements may occur in the limbs or in limited muscular areas. Sometimes these convulsions are followed by local temporary paralysis. Sometimes there is rigidity of the cervical muscles and retraction of the head. Bedsores tend to form; the lips become swollen, and the saliva dribbles from the mouth. Gradually the lethargy deepens, the body wastes, the bedsores extend, the sphincters relax, and finally the patient dies comatose or sinks from slowly advancing asthenia. Possibly he succumbs to convulsions, hyperpyrexia, pneumonia, dysentery, or other intercurrent condition.
The manifestations described are subject to considerable variations. Mania is not uncommon; delusions may present themselves, or psychical and physical symptoms not unlike those of general paralysis of the insane are developed.
During the whole course of the nervous stage of trypanosomiasis the other symptoms already described as characteristic of the infection may be in evidence. The knee-jerks, though lost towards the end, are active at first; the fundus oculi is normal; the sphincters, until towards the end, are controlled; the urine is normal, and the bowels, although generally tending to constipation, act with more or less regularity.
- ↑ * In German East Africa, out of 55 patients in the last stages of the disease only 5 had sleep symptoms. Exophthalmos was noted 16 times.
