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natives  were  seen  only  once,  and  it  is  possible,  theiefore,  that  had  we 
been  able  to  examine  them  more  frequently  a  still  greater  percentage 
of  them  might  have  been  found  to  be  infected. 
A  word  may  be  said  here  with  reference  to  the  classification.  In 
all  our  ‘  +  ’  cases  the  enlargement  was  relatively  enormous,  so  mudi 
so  that  in  several  of  them  the  glands  could  easily  be  recognised,  on 
casual  inspection,  as  irregular  swellings  at  the  sides  of  the  neck.  We 
had  the  opportunity  of  seeing  the  great  majority  of  the  other  cases 
found  in  the  country,  and  111  these  the  enlargement  was  also  extremely 
well  marked,  so  that  there  could  not  be  any  hesitation  in  assigning 
them  to  this  particular  class.  All  the  glands  were  freely  moveable, 
separate  from  one  another,  and  of  the  peculiar,  and  almost  diagnostic, 
consistency  which  Hodges*  has  aptly  compared  to  that  of  a  ripe 
damson. 
In  the  one  positive  ‘  ’  case  we  were  led  to  suspect  the  presence 
of  the  disease  by  this  feature  alone,  before  puncture  had  revealed  the 
trypanosomes  in  the  gland  juice. 
Xhe  ‘  y - ’  class  included  glands  which  are  usually  few  in 
number,  and  which  are  very  small  and  hard — like  BB  shot.  They  are 
most  commonly  found  at  the  apices  of  the  posterior  cervical  triangles, 
and  as  we  have  already  pointed  out,  have  no  specific  import,  so  that  | 
a  clear  distinction  may  be  drawn  between  them,  as  being  merely  j 
‘  palpable  ’  as  opposed  to  ‘  enlarged.’ 
The  intermediate,  or  ‘  ^  ’  class,  we  have  found  to  be  of  little  use,  | 
and  our  results  point  to  the  conclusion  that  this  group  is  perhaps 
superfluous.  In  any  such  arbitrary  classification,  however,  so  much 
depends  upon  the  interpretation  of  the  individual  that  it  is  as  well  that 
a  somewhat  smaller  measurement  should  be  adopted  than  the  one  , 
which  would  indicate  with  any  degree  of  certainty  the  presence  of 
trypanosomes.  This  means  but  little  extra  work,  and  increases  the 
efficiency  of  the  method.  Our  experience  bears  out  that  of  Dutton 
and  Todd,t  and  of  Martin  and  Leboeuf,j;  that  the  larger  the  glands 
the  more  likely  is  one  to  find  trypanosomes,  that  is  in  early  cases  of 
the  disease. 
*  Hodges,  1907,  Colonial  reports,  Uganda,  No.  4662. 
t  Dutton  and  Todd,  1906,  Liverpool  School  of  Tropical  Medicine,  Memoir 
XXL 
t  Martin  and  Leboeuf,  igo8.  Bulletin  Soc.  Path,  exotique  T.,  No.  8. 
