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biting  flies,  tsetse  more  particularly.  To  a  great  degree  it  may  be 
attributed  to  general  dirtiness,  which  is  always  more  marked  amongst 
the  children. 
..\t  one  village,  near  the  Luangwa  river,  where  the  natives  were  particularlv 
c5irty,  we  were  told  that  they  did  not  wash,  as  they  were  afraid  of  catching  cold. 
Conjunctivitis  and  purulent  discharges  from  the  nostrils  are 
extremely  common  in  babes.  In  some  districts,  skin  diseases,  such  as 
‘  mperi,’  or  itch,  are  frequent,  and  in  others,  e.g.,  amongst  the  Ankonde 
at  the  north  end  of  Lake  Nyasa,  filariasis  may  be  responsible  to  some 
extent.  There,  nearly  every  man  has  some  degree  of  lymph  scrotum, 
and  filaria  may  be  found  in  the  juice  of  the  lymphatic  glands.  It  has 
also  seemed  to  us  that  there  are  tribal  differences,  for  in  those  which 
are  comparatively  cleanly,  e.g.,  the  Awemba,  the  smaller  incidence  is 
quite  noticeable.  This  supports  the  supposition  of  the  enlargement 
being  due  largely  to  general  filthiness. 
.Since  Dutton  and  Todd*  laid  such  emphasis  on  gland  palpation 
and  puncture,  particularly  in  the  early  stages  of  the  disease,  consider¬ 
able  discussion  has  arisen  not  only  as  to  its  value  as  a  method  of 
diagnosis,  but  also  to  the  efficiency  of  the  measures  of  prophylaxis 
based  on  its  application.  Their  original  conclusions  were: 
1.  ‘Gland  palpation  is  by  far  the  most  efficient  method  of 
demonstrating  the  presence  of  trypanosomes  in  cases  of  trypano¬ 
somiasis.’ 
2.  ‘Asa  rule,  enlarged  cervical  glands,  without  obvious  cause,  do 
not  occur  in  districts  from  which  trypanosomiasis  is  absent,’  with  the 
corollary  that  ‘  every  negro  with  enlarged  glands  must  be  considered, 
until  the  contrary  is  shown,  to  be  a  case  of  trypanosomiasis.’ 
3.  ‘  Early  cases  of  trypanosomiasis  have  enlarged  glands,  and 
will,  therefore,  be  detected  by  gland  palpation.’ 
As  in  the  countries  with  which  we  are  dealing  the  detection  of  the 
early  cases  is  the  end  in  view,  we  shall  restrict  out  attention  as  far  as 
possible  to  these. 
1.  ‘Gland  palpation  is  far  the  most  efficient  method . 
*  Dutton  and  Todd,  igo6,  T.iverpool  School  of  Tropical  Medicine, 
Xo.  XXI. 
