SPLENOMEGALY 215 
negro, even in those who had lived for a number of years on the mainland under 
the same environment as the Latin-Americans. 
In other parts of Africa, the splenomegaly very frequently follows infection 
with Schistosoma. This fact has been especially emphasized by Ferguson ! and 
Day? and by Richards * and more recently by Bonnin,‘ Schweizer,’ Coleman,° 
Stiven ’ and Girges.® 
In Amazonia infection with Schistosoma has not been observed. It is im- 
portant definitely to determine whether all the splenomegaly of Amazonia is a 
manifestation of malarial infection or whether some of it does not represent a 
form of splenic anaemia of other origin. 
Summarizing the cases of splenomegaly observed during the present Ex- 
pedition, it is of interest to note that the malaria cases in which parasites oc- 
curred in the blood showed a splenic index of 22.4 per cent. However, the 
index for the consolidated survey, including many in which blood smears were 
lost or destroyed, was 18.6 per cent. Very large spleens were rare in Liberia. 
In only 4.7 per cent was the spleen markedly enlarged. This is a very low rate 
as compared with Amazonia. Table III illustrates the results of special splenic 
surveys carried on in Liberia. There were eight other cases of splenomegaly ob- 
served where malaria or tuberculosis were probably concerned in the enlarge- 
ment. Of three advanced cases of splenomegaly seen during the present African 
Expedition, one was observed at Yakusu in the clinic of Dr. Chesterman, in a 
man aged forty to forty-five, whose general health was apparently fair. The 
abdomen of this patient was much enlarged and the spleen extended below the 
umbilicus and across the median line to the right. The liver was not palpable 
and there was no ascites or general glandular enlargement. The diagnosis made 
by examination of fresh and stained blood films was lymphatic leukemia. In 
the second case of marked splenomegaly, which also showed enlargement of the 
liver with ascites, the ova of Schistosoma haematobium were found in the urine, 
and there were no malarial parasites in the blood (see Schistosomiasis, page 226, 
Case 202). In the third case observed in a girl aged ten years, the patient 
complained of cough, but looked healthy, and the mucous membranes were 
of good color. However, there were rales in the right side of the chest. The 
spleen was palpable for a distance of about 10 cm. below the costal margin. 
The blood was negative for malaria. Splenic puncture and cultures did not 
reveal any parasites or structures suggesting mycotic infection. 
We have discussed previously at some length, in the Report of the Amazon 
Expedition (1926),° the etiology of the different forms of tropical splenomegaly. 
Since the publication of this report and during the year spent upon the present 
1 Ferguson and Day: Ann. Trop. Med. & Parasit. (1909), III, 379. 
2 Day: Trans. Royal Soc. Trop. Med. and Hyg. (1924), XVIII, 121. 
3 Richards: British Jour. Surg. (1914), I, 418. 
4 Bonnin: Gaz. hebd. Sci. Méd. de Bordeaux (1928), XLIX, 387, 403. 
5 Schweizer: Schweiz. Med. Woch. (1927). LVII, 1017. 
6 Coleman: Trans. Royal Soc. Trop. Med. and Hyg. (1926-1927), XX, 224. 
7 Stiven: London Hosp. Gaz. (1928), XX XI, 225. 
8 Girges:: Jour. Trop. Med. and Hyg. (1929), XXXII, 280. Ibid. (1930), XX XIII, No. 1, p. 1. 
® Strong and Shattuck: Medical Report of Hamilton Rice 7th Exped. to Amazon (1926), p. 74. 
