2g8 
polyadenitis.’  While  this  is  broadly  true,  glandular  enlargement  is 
not  an  absolutely  constant  sign  in  the  early  stages  of  the  disease,  for 
cases  have  been  diagnosed  in  which  the  glands  had  not  become 
palpable.  About  8  per  cent,  of  known  cases  of  trypanosomiasis  will 
not  be  detected  by  gland  palpation. 
The  great  divergence  of  opinion  that  exists,  is,  in  regard  to  the 
application  of  gland  palpation  to  methods  of  prophylaxis  ;  the  chief 
objections  being  that  it  fails  to  detect  an  appreciable  number  of  the 
cases,  that  it  entails  hardship  on  those  natives  unfortunate  enough  to 
have  big  glands,  that  the  natives  will  evade  its  application,  and  that  it 
is  an  expensive  scheme  to  carry  out.  The  second  and  third  of  these 
items  need  not  be  considered,  as  the  objections  cannot  properly  be 
against  the  method  ;  since,  if  they  occur,  they  are  attributable  to 
injudicious  handling  of  the  natives  by  the  officials  concerned  in  the 
work.  The  objection  that  all  the  cases  will  not  be  found  by  the 
method  is  valid.  In  order  to  stamp  out  the  disease  in  a  district,  the 
ideal  procedure  would  be  to  stop  absolutely  native  movements,  and 
to  prevent  the  infection  of  fresh  natives  in  the  area,  by  the  isolation  of 
every  case  of  the  disease  and  the  removal  of  the  remaining  population 
from  contact  with  tsetse  flies,  Glossina  palpalis  more  particularly. 
Since  it  is  manifestly  impossible  to  carry  any  such  scheme  entirely 
into  effect,  we  have  to  revert  to  measures  which  will  tend  to  check 
the  spread  of  the  disease,  even  though  these  be  imperfect.  Dutton 
and  Todd  do  not  claim  that  their  procedure  will  entirely  prevent' 
Sleeping  Sickness  from  spreading  ;  all  they  say,  is,  that  it  will  prevent 
the  disease  from  infecting  new  districts  with  the  rapidity  noticed  in 
the  past,  and  in  the  meantime  improved  methods  both  of  prophylaxis 
and  treatment  may  be  brought  to  light.  .So  far  as  treatment  is 
concerned,  we  are  in  much  the  same  position  as  we  were  four  or  five 
years  ago,  that  is  to  say  the  results  are  not  at  all  promising,  so  that 
we  are  still  compelled  to  fall  back  on  imperfect  methods  of  checking 
the  advance  of  the  disease.  If  natives  are  to  be  allowed  to  pass  from 
infected  to  non-infected  regions,  the  fact  remains  that  no  better 
method  of  detecting  the  disease  in  the  early  stages  has  yet  been 
put  forward  than  the  application  of  gland  palpation.  Of  course  to 
complete  the  method,  gland  puncture  must  be  employed  as  well,  and 
this  has  always  been  stated  to  be  an  integral  part  of  the  procedure. 
It  is  surely  better  to  stop  the  nine  out  of  ten  cases,  which  the  method 
