The disease may run its course in a few months or it may take years. The symptoms are various, but infection is usually soon followed by fevers, sometimes mild, sometimes severe, which recur at irregular intervals. Certain glands or other parts of the body may become swollen. More or less extensive skin eruptions occur on all parts of the body and the patient gradually becomes anemic and physically and intellectually feeble. The nervous system seems to be affected by the parasite, either directly or by the action of the toxins it produces. The patient becomes more debilitated and morose with an increasing tendency to sleep, hence the name sleeping sickness. As the stupor deepens the patient looses all desire or power of exertion and as little food is taken he rapidly wastes away and finally succumbs for after this final stage is reached there is no relief. It is definitely known that a species of tsetse-fly, _Glossina palpalis_ (Fig. 112), which somewhat resembles our stable-fly, is responsible for the dissemination of the disease, and some recent investigators have suggested that certain species of mosquitoes may also carry the parasite from one host to another. There still remains some doubt as to the exact manner in which the fly transmits the disease, but it seems altogether likely that it is an alternative host and does not serve as a simple mechanical carrier. In this respect it is like the mosquito which is one of the necessary hosts of the malaria parasites, and unlike the house-fly which carries the germs of various diseases in a purely mechanical way without serving as a definite necessary host for the parasite. The tsetse-fly is found only in tropical Africa and is limited in its distribution there to certain very definite, narrow, brushy areas along the water's edge. If these places can be avoided there seems to be little danger. Those who are fighting the disease have found that if the brush in the vicinity of watering-places and ferry-landings is cleared away such places become comparatively safe. These flies do not lay eggs but produce full-grown larvæ which soon pupate in the ground. ELEPHANTIASIS In many tropical regions human blood as well as that of other animals is the normal habitat of certain worm-like parasites (Nematodes). They are not entirely confined to the tropics but may extend far up into the subtropical regions. Five or six different species of these parasites are known, only one of which, however, has been shown to be of any pathological importance, as far as human beings are concerned. [Illustration: FIG. 111--_Trypanosoma gambiense_; various forms from blood and cerebrospinal fluid. (After Manson.)] [Illustration: FIG. 112--Tsetse-fly. (After Manson.)]