Extremely important in diagnosis are the glandular enlargements of which those of the upper posterior cervical triangle are the most characteristic (Winterbottom’s sign). Gland juice is more apt to contain trypanosomes than the smear from the blood. Deep hyperaesthesia is also a very characteristic symptom (Kérandel’s sign).
When the trypanosomes are found in the cerebro-spinal fluid we have the second stage of trypanosomiasis or that of sleeping sickness. This is ushered in by a tremor of the tongue and mental symptoms of great apathy and listlessness. An irregular fever is present at times during the course of this stage of sleeping sickness but toward the end of the disease the temperature tends to be subnormal.
Progressive weakness and emaciation with finally a comatose state are features of the terminal weeks.
Brazilian Trypanosomiasis.—The disease begins acutely in young children with an irregular remittent fever. The parasites are not apt to be found except during the fever. The lymphatic glands become swollen. With repeated accessions of fever, followed by apyrexial intervals, the child becomes weaker and more anaemic. The spleen is enlarged. This infection is very fatal for children.
In adults the disease tends to assume a chronic type and often, from involvement of the thyroid, gives symptoms of myxoedema.
Bacillary Dysentery.—The onset may be quite sudden and the temperature rise to 102°F. or 103°F. There is apt to be some evidence of toxaemia as shown by headache, slight flightiness and gastric upset. The dysenteric stool is of a whitish, mucopurulent appearance and flecked or streaked with blood rather than showing the uniformly brownish or greenish gelatinous material of amoebic dysentery.
In very severe bacillary dysentery algidity may come on with a cold clammy skin, reminding one of cholera. At such times the temperature is subnormal.
Liver Abscess.—In the so-called pre-suppurative stage of amoebic hepatitis the only symptom may be an irregular remittent fever of moderate degree. This and a leucocytosis may be the only points noted.
In fully developed liver abscess we have a painful liver which is enlarged upward often with pain referred to the right shoulder and a crepitation at the base of the right lung. The fever is distinctly hectic in type with an evening rise and associated with profuse sweatings. The evening rise of temperature does not usually tend to exceed 102°F. and apyrexial intervals are frequently observed in the fever chart.