GLAND PUNCTURE IN TRYPANOSOMIASIS 99 
white cells carefully drawn up together with a small quantity of serum by means of 
a capillary pipette. It the operation is well done only sufficient material tor one 
coverslip preparation is obtained. 
Although such methods are exceedingly efficient, periods do occur during which 
the most careful examination fails to find trypanosomes in the blood of even advanced 
cases of sleeping sickness in whom parasites have previously been very numerous. 
(Fig. 1). Much less, then, can once or twice repeated negative examinations of 
blood from a merely-suspected person be accepted as proving non-infection. 
The introduction of lumbar puncture in cases of sleeping sickness by Castel- 
lani supplied a new and valuable diagnostic method, and not infrequently the deposit 
derived by centrifugalizing from fifteen to twenty c.cm. of spinal fluid showed parasites 
in individuals from whose blood they had been persistently absent. 4 In early cases 
of sleeping sickness, however, the conditions were frequently reversed, and trypano- 
somes were found in the blood, while examinations of the cerebro-spinal fluid remained 
negative. 5 Neither method, then, can be entirely relied upon. In addition, both spinal 
puncture and the centrifugalizing of blood require too much time and technique for 
either to ever become a commonly employed diagnostic method. 
The examination of spleen pulp and serous fluids (hydrocele) gave, sometimes 
startling, 4 but no constantly positive, results. 
Although it is scarcely worthy of being considered a diagnostic method, we 
mention a phenomenon 3 frequently observed in ordinary vaseline-sealed coverslip 
preparations of fresh blood from cases of trypanosomiasis. The red cells, instead of 
forming rouleaux as normally, run together into formless clumps and huge agglomerate 
masses. The condition is easily recognized macroscopically, and the sandy, granular 
appearance of the preparation is very characteristic. Although this condition is not 
always seen in infected bloods, and is sometimes observed in preparations from cases 
who have never been infected, still it has so constantly b^en associated with the presence 
of trypanosomes that bloods which ' agglutinate ' in this manner are looked upon with 
the greatest suspicion. More than once has the ' agglutination ' encouraged the con- 
tinuance of an ultimately successful search for parasites. Only once 4 have we had the 
opportunity of observing a patient (European) from whose blood trypanosomes, once 
present, have finally disappeared. In this instance autoagglutination of the red cells 
disappeared with the parasites. 
One of the great interests of the note 5 from Capt. Greig and Lieut. Gray, 
recently communicated by Bruce, was that it suggested a new* and possibly more 
perfect method of demonstrating the parasite in early cases of trypanosomiasis. 
By a comparison of the results obtained from the simultaneous examination of 
blood, gland juice, and cerebro-spinal fluid from a series of fourteen suspected, though 
very early, cases of ' sleeping sickness,' we satisfied ourselves that, as a rule, trypanosomes 
* Kanthack, Durham, and Blandford 3 had already noted that parasites might occasionally be present in the glands, though 
absent from the blood, of animals infected with T. brucei. 
