_The Lymphatic System._—Most important in diagnosis is the enlargement of the lymphatic glands, especially those of the posterior cervical triangle (Winterbottom’s sign). Other enlarged glands may be the supraclavicular, epitrochlear and axillary glands. The inguinal glands suffer enlargements so frequently as the results of wounds and infections of the foot that their enlargement is of less diagnostic value. The natives of certain parts of Africa not only attach great diagnostic importance to gland enlargement but they imagine they cure the disease by removing the glands with various primitive cutting tools. The glands are not painful, do not become matted together and rarely suppurate. Our best means of diagnosing trypanosomiasis is by withdrawing gland juice with a syringe and examining the smears. _The Skin._—Erythematous areas may be present in Europeans. Localized oedemas are rather marked features. The skin may be very dry and itch markedly. _Other Manifestations._—The spleen may be enlarged, the respirations may be more rapid than normal and the blood show a secondary anaemia. In a blood examination the large mononuclears show an increase with a normal white count. The eye may show keratitis or irido-cyclitis in trypanosomiasis. Trypanosomiasis seems to favor abortion and still-births, in this respect resembling syphilis. DIAGNOSIS In making a survey of a native population Schwetz considers gland palpation as almost as reliable as gland puncture and of course more expeditious. The typical gland should be large and soft or elastic although he admits trypanosomes may be found in small hard glands. When the glandular enlargement is distinct, with the erythema and headache, there is much that suggests syphilis. Another point of confusion is that positive Wassermann tests are often obtained in sleeping sickness. The increase in large mononuclears goes with malaria, kala-azar and syphilis as well as with trypanosomiasis so that such findings are of little assistance in differential diagnosis. An early history of attacks of fever, with marked fluctuation of temperature, associated with rapid pulse, even with the apyrexial morning fall, is suggestive. Then with the glandular enlargements we think immediately of laboratory examinations. As with pellagra the history is very important in the diagnosis of trypanosomiasis. _For the laboratory diagnosis_ we may use peripheral blood with some thick film method. The examination of preparations from the peripheral blood is usually very discouraging. Very much better results (in fact some prefer this method to any other) can be obtained by taking 10 to 20 cc. of blood in about 25 cc. of citrated salt solution, centrifuging 2 or 3 times and examining the sediment of the third centrifugalization. Dutton and Todd prefer to centrifuge citrated blood and to collect the leucocyte layer for examination as is done in opsonic work.