Cholesterin has been given in 15-grain doses in suspension in thick milk every four hours with the idea that it is anti-haemolytic. The dose is repeated 2 or 3 times. Calomel in large doses has been recommended by some tropical practitioners but it would seem advisable only to use calomel to keep the bowels open and then in small divided doses. Antipyretics should not be used from their depressing action on the heart. For the urinary suppression, Wallace recommends salines as hot as can be borne, administered high in the colon by a double-flow tube. Since he found this treatment effective after intravenous and rectal injections had failed, it is to be inferred that the results obtained were due not to the further administration of fluid but to the action of heat applied directly to the splanchnic area. CHAPTER III THE TRYPANOSOMIASES DEFINITION AND SYNONYMS =Definition.=—African trypanosomiasis is an important protozoal disease of Central and West Africa, due to a flagellate, _Trypanosoma gambiense_, and transmitted by a tsetse fly, _Glossina palpalis_. The trypanosome undergoes a developmental cycle in the fly which does not become infective until after about twenty days. The period of incubation is about two or three weeks, after which an irregular fever with approximately normal morning temperature and high evening rise appears, attended with a rapid pulse rate at all times. This is called the stage of trypanosome fever and may show trypanosomes in the peripheral blood. Later on the glands enlarge and gland juice shows trypanosomes. With the appearance of a fine tremor of the tongue, a state of apathy or lethargy, known as sleeping sickness, sets in, attended with trypanosomes in the cerebro-spinal fluid. Gradually increasing mental deterioration marks the almost invariable course to death. A more virulent type of trypanosomiasis is found in Rhodesia. In Brazil there is a disease caused by a flagellate, _Schizotrypanum cruzi_, which resembles a trypanosome and is transmitted by a bug, _Lamus megistus_. The disease runs an acute course with a high fever and great mortality in infants showing chiefly manifestations of involvement of brain or thyroid gland. In adults it runs a chronic course showing neurological manifestations or signs of myxoedema or even of Addison’s disease. =Synonyms.=—Sleeping sickness; Negro lethargy. French: Maladie du sommeil. German: Schlafkrankheit. For the Brazilian trypanosomiasis, Schizotrypanosomiasis; Chagas’ disease. HISTORY AND GEOGRAPHICAL DISTRIBUTION =History.=—In describing sleeping sickness, in 1803, Winterbottom brought out the importance of enlargements of the posterior cervical glands (Winterbottom’s sign).