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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. 
