The introductory stage of the eruptive fevers is often characterized by somnolence. It also frequently appears as the forerunner of coma in the various diseases which terminate in unconsciousness and death. A singular example of this has been observed among the negro inhabitants of the Atlantic coast of tropical Africa. The disorder is known to English writers as _sleeping dropsy_; by the French it is called _maladie du sommeil_. It is characterized by daily paroxysms of somnolence which tend to become more and more continuous and profound until they are finally merged in fatal coma. For our knowledge of the disease we are chiefly indebted to the description by Clark,[23] an English surgeon who practised in Sierra Leone, and to the monograph by Guerin,[24] a French naval surgeon, who had enjoyed exceptional opportunities for observation among the laborers who had been carried from Africa to the island of Martinique. Similar cases have been occasionally reported in other regions of the world, but it is among the Africans that it has been principally remarked. The onset of the malady is gradual, commencing with a slight frontal headache. After a few days a disposition to sleep after meals is noted. This becomes increasingly urgent, and the intervals of sleep are prolonged until at length the patient becomes continually soperose. The waking periods are marked by a sluggish state of the intellectual faculties. The pulse is not accelerated, and it remains full and soft. The veins of the sclerotic are turgid, and the eyeball seems unusually prominent. The temperature does not increase, but rather tends to diminish its figure. The skin is dry and moderately cool. The tongue continues moist, and is covered with a white fur. The bowels and the bladder are regularly emptied, and the appetite persists with considerable vigor. Finally, the patient becomes completely comatose, and dies quietly. Sometimes, however, the evolution of the disease is less tranquil. Epileptiform convulsions, followed by progressively deepening periods of coma, interrupt its course, and a continuous muscular agitation marks the closing scene. At the same time the pulse grows weaker and more frequent until its movements cease in death. Recovery is almost unknown, though the duration of the disease often varies from three months to a year or longer. Examination of the body after death yields very negative results; the sinuses and larger vessels of the brain are engorged with blood, but no evidence of inflammation is anywhere apparent. The other organs present no pathological alterations whatever. These observations seem to indicate that the disease originates in some form of general blood-poisoning, rather than in any local inflammation or degeneration. Dr. Clark has called attention to an enlargement of the cervical glands as a feature of the malady. According to Dr. G. H. Bachelder,[25] the native physicians cure the disease by extirpation of the affected glands. He has also