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minute drop of citrate solution or salt (Greig and 

 Gray). Examine with a one-sixth inch. This is by far 

 the easiest and most certain way of making a diagnosis. 



Lumbar Puncture. Place the patient on his 

 right side with the knees drawn up to the face, so as 

 to get a position of extreme flexion of the lumbar 

 vertebrae. The tips of the fingers of the left hand are 

 then placed upon the left iliac crest, when the thumb 

 will indicate the site of puncture (between the fourth 

 and fifth lumbar vertebrae) which lies half an inch to 

 the left of the middle of a line joining the two iliac 

 crests. Insert a stout hypodermic needle for one to two 

 inches until it is felt free in the canal. Draw off about 

 twenty c.c. and centrifugalise for half an hour. Examine 

 the sediment. Within one hundred days of death 

 trypanosomes are practically always present, except 

 sometimes a day or so before death. 



5. Scarification. Of the erythematous patches 

 often seen in trypanosomiasis in the European, may give 

 a positive result when the blood examination is negative. 



Occurrence of Streptococci. A diplo-streptococcus 

 can frequently be isolated by culture from the glands 

 and cerebro-spinal fluid in cases of sleeping sickness. 

 Thus Greig and Gray, in an examination of eighteen 

 cases which terminated fatally, found in the glands 

 streptococci in fifty per cent., and trypanosomes in 

 one hundred per cent. ; in the cerebro-spinal fluid 

 streptococci in forty-four per cent., and trypano- 

 somes in one hundred per cent, of cases ; but in the 

 majority of cases the streptococci were detected a day 

 or so, or even only a few hours before death, so that the 

 streptococci represent a terminal infection and are not 

 in any way the cause of the onset of symptoms. 

 Further, death can occur with all the typical symptoms 

 and yet the organs prove sterile. 



