22 THOMPSON YATES AND JOHNSTON LABORATORIES REPORT 
Enlargement of the spleen was observed in the younger cases. But 
this is without significance since that organ is enlarged in nearly all Gambian 
native children. 
Enlargement ot lymphatic glands is also by no means unusual in native 
children. 
The history of possible loss of weight and strength with fever was 
given in four cases ; definitely in only two. 
The remaining cases believed themselves to be perfectly healthy. Two 
boasted of their extraordinary vigour, and neither of the adult males were 
impotent. In appraising the value of the past history of these cases, we must 
remember that a native does not reckon time or observe himself so accurately 
as does a European. In addition, he will very often say what he imagines 
will please his questioner. Even if his story of past fevers and loss of weight, 
during the rainy season, is correct, it must not be forgotten that there are 
many other diseases which produce like symptoms. 
We must, therefore, rely altogether on our objective examination, and 
this, unfortunately, was necessarily curtailed because travelling made it impossible 
to keep each case under observation for any length of time. 
Taking all our facts into consideration, we believe the disease, as it 
occurs in natives, to be a peculiarly mild one, and that it is at present 
impossible to recognize it clinically. 
The accelerated pulse and respiration rate, slight rise of temperature and past 
history of fever occurred not unfrequently amongst many of those in whom no 
trypanosomes were found.* 
The abnormal results of the blood counts must not be assumed to be specific. 
An enormous percentage of these natives were infected, in varying degree, with 
filariae, and all may be assumed to have had intestinal parasites. The quantitative 
estimation of blood cells and haemoglobin shows a constant diminution of these 
elements as judged by the European standard. What the normal for an African may 
be we have no means of determining. 
The differential leucocyte counts show a constant increase of eosinophils, mast 
cells, and mononuclear elements. The proportional increase being greatest in the 
cases of the eosinophiles and mononuclear large cells. 
In slides coloured by the previously mentioned modification of Romanowsky's 
stain many of the mononuclear cells were seen to contain deep, rich lake-coloured 
granules. The number of granules present in each cell ringed from, perhaps, twenty 
to eight or ten or even less. Their size and shape varied as much as their number. 
They varied from regular oblongs, as long as eosinophile granules, to mere points of 
colour. A small unstained area was often seen to partially surround these granules. 
* A series of pulse rates taken at random from apparently healthy children, in whom no trypanosomes were found, 
showed that an increased pulse rate, ninety to one hundred, was not at all uncommon. 
