_Gland Puncture._—The English workers usually prefer the gland puncture method, using a sterile but dry hypodermic needle. Water in the needle distorts both leishman bodies and trypanosomes. In the sleeping-sickness stage trypanosomes can almost constantly be found in the cerebro-spinal fluid. In a diagnostic study of 336 cases Broden obtained 87% of positives from gland puncture, 80% from centrifugalizing the supernatant fluid left from the second centrifugalization of the blood and 4.5% from spinal fluid examinations. Some prefer to inoculate susceptible animals, particularly the guinea pig or monkey, with blood or gland juice from the suspected case. A very satisfactory material is an emulsion from an excised gland which may be inoculated intraperitoneally into white rats. The further course, after animal inoculation, is the examination of the blood of these animals for trypanosomes. Usually at the time the guinea pigs die we find numerous trypanosomes. Other tests are: (1) Trypanolysis, when unheated suspected serum and trypanosomes are incubated together for one hour. Normal serum may occasionally cause disintegration and treated cases give it in only about 45% of cases. Unfavorable untreated cases give it in about 80% of cases. (2) The so-called auto-agglutination test is not of much value. In this the red cells of the blood of a trypanosomiasis case come together in clumps when one makes a wet preparation. It is not a rouleaux formation. (3) The attachment test is made by making a mixture of inactivated serum, leucocytes and trypanosomes and allowing them to be in contact for 20 minutes. A positive test shows attachment of the trypanosomes to the leucocytes. PROGNOSIS If the patient cannot be removed from the infected district or cannot receive the atoxyl or atoxyl-tartar-emetic treatment the prognosis is almost surely that of a prolonged but fatal end. There is very little hope of cure if the disease has gone on to the sleeping-sickness stage. PROPHYLAXIS AND TREATMENT =Prophylaxis.=—The question of depopulation of districts and destruction of the big game therein, when the area is infected with _Glossina palpalis_, has been fully considered under epidemiology. Isolation, in the fly-free districts, of infected natives has not proven a very practical measure but that of rendering their peripheral blood free of trypanosomes by atoxyl injections would seem more desirable. In this we aim to cure the patient as well as render him safe to others. The most practical measure is that employed in Uganda of clearing the plant and tree growth for at least fifteen feet from the streams of water, it having been noted that the tsetse flies confine themselves to a narrow strip not more than fifteen feet from the water’s edge. The tsetse fly requires considerable moisture for its existence.