297 
where,  moreover,  the  men  engaged  in  the  work  are  not  furnished  with 
an  elaborate  equipment,  there  can  be  little  doubt  that  the  method  of 
gland  palpation  and  puncture  is  the  most  serviceable  method  and  the 
one  which  must  be  adopted  as  a  routine  measure. 
2.  ‘  As  a  rule,  enlarged  cervical  glands,  without  obvious  cause, 
do  not  occur  in  districts  from  which  trypanosomiasis  is  absent,' 
Low  was  the  first  to  dissent  from  this  statement,  and  he  pointed 
out  that  enlargement  of  the  glands  was  common  amongst  natives, 
unassociated  in  any  way  with  Sleeping  Sickness.  The  truth  of  the 
above  dictum  depends  almost  altogether  on  the  meaning  which  is 
attached  to  the  word  ‘  enlarged.’  If  this  is  taken  to  mean  any  gland, 
however  small,  which  can  be  distinctly  palpated,  the  observations 
which  have  been  made  on  the  question,  enable  us  to  say  at  once  that 
there  is  very  little  truth  in  it.  If  we  are  to  take  it  that  by  ‘  enlarged  ’ 
we  are  to  understand  glands  measuring  approximately  1-5  x  075  cm., 
the  case  is  different.  The  figures  given  by  Dutton  and  Todd  lend 
some  colour  to  this  supposition,  for  of  157  ‘  n - ’  and  ‘  ^  ’  glands 
punctured  by  them,  both  in  infected  and  uninfected  regions,  only  two 
were  found  to  be  infected.  A  distinction  must  be  drawn  between 
infected  and  non-inf ected  regions,  for  in  the  former,  as  Dutton  and 
Todd,*  Neavet  and  others  point  out,  glandular  enlargement  is  much 
more  common  than  in  the  latter,  and,  in  addition,  glands  of  the  larger 
class  are  much  more  abundant.  Neave  says  ‘  This  would  tend  to 
show  that  trypanosomiasis  is  accountable  for  enlargement  of  glands 
of  any  size.’ 
On  the  whole,  our  results  in  Rhodesia,  a  supposedly  non-infected 
region,  bear  out  those  of  Dutton  and  Todd.  As  we  have  already 
pointed  out,  glandular  enlargement  in  the  wide  acceptation  of  the 
term  has  no  particular  significance,  but  in  the  case  of  glands  of  the 
+  class,  in  four  out  of  five  examinations  the  natives  showing  them 
were  infected  with  trypanosomes. 
3-  Early  cases  of  trypanosomiasis  have  enlarged  glands,  and  will 
therefore  be  detected  by  gland  palpation.’ 
That  the  first  part  of  this  statement  is  correct  is  recognised  by  all 
workers.  Greig  and  GrayJ  state  that  ‘  the  disease  is  at  first  a  specific 
Dutton  and  Todd,  igo6,  Memoir  XXI,  Liverpool  School  Trop.  Med. 
+  Repoil;  of  Katanga  Medical  Commission. 
+  reig  and  Gray,  T905,  Royal  Soc.  Sleeping  Sickness  Reports,  No.  VT. 
