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6. The gland juice in a certain proportion of cases in the last stage of the disease becomes infected by bacteria, especially diplo- streptococci.

In view of the fact that some importance has been attached to streptococci as playing a part in the causation of sleeping sickness, a series of examinations of the gland juice were made in a number of cases at intervals in the course of the disease microscopically and culturally. The result of these observations showed, that a number remained cases of pure trypanosoma infection to the end, the cultures made from the glands, blood and cerebro-spinal fluid remained sterile. On the other hand in a proportion of cases an invasion, chiefly by diplo- streptococcus, did occur, but by the results of the examination at different stages of the disease it was possible to locate it to the final stage of the disease, when the patient was practically monbund.

These cases at this stage of the disease have invariably numerous foci of suppuration on the hands and feet due to jiggers, also there is frequently before death a purulent discharge from the gums : their vitality and resisting power is a negative quantity.

The results are fully recorded in the histories of the cases of sleeping sickness given in the Appendix. The following table shows the frequency of the occurrence of this bacterial invasion in sleeping sickness cases and the period of the disease at which it takes place :—