234 REPORT OF THE HARVARD AFRICAN EXPEDITION 
that only the female fly bites and that darkness is essential for this; even a 
candle placed within a tent would keep Culicoides away and a full moon would 
give almost complete protection from bites. This fly furthermore showed a 
decided tendency to bite black rather than white skins. 
At Mamfe in the British Cameroons, Sharp found over seven per cent of 
the wild flies to be naturally infected with A. perstans. He remarks that the 
incidence of infection in the natives in this region is not less than 92 per cent. 
This is obviously far greater than it is in Liberia. This species has been found 
by Ingram and Macfie to be widely distributed in Sierra Leone and is also 
known to prevail in many other localities along the West Coast. 
Culicoides grahami was collected by Dr. Bequaert both in the interior of 
Liberia and in the Belgian Congo. This midge, however, was not found in 
very great abundance in Liberia during the time that we were in that country. 
Most authorities including Stephens and Yorke ! attribute no definite symp- 
toms of disease to Acanthocheilonema perstans. However, Morenas ” has recently 
reported a case of infection with this parasite in which there was an eosino- 
philia of fifty per cent and attacks of urticaria and of fugitive oedema with 
localized tumors of the nature of Calabar swellings. Later dyspnea and oedema 
of the legs occurred and the patient succumbed. At the necropsy there was 
cardiac thrombosis, myocarditis, with hypertrophy of the spleen and of the 
liver. Morenas thinks the eosinophilia and cutaneous symptoms were due 
to A. perstans. 
Elephantiasis in its more advanced forms, particularly of the lower extremi- 
ties and scrotum, was also found to be common in Liberia and particularly 
among the adult Krus. Speaking generally, the cases of elephantiasis were 
more common and advanced among the people of Liberia on the coast than 
among those in the interior. The condition was, however, even more fre- 
quently met with in parts of the central Belgian Congo. In the hospitals of 
the Belgian Congo it was not infrequent to observe several patients with ele- 
phantiasis of the scrotum who had come for operation. The tumors not in- 
frequently weighed from twenty-five to seventy-five pounds (No. 172). Although 
the surgical technique is often not very good in some of these Belgian hospi- 
tals, the patients usually recover after operation and removal of the growth. 
The skin of the more advanced cases of elephantiasis, while sometimes 
smooth, is generally rough, thickened, fissured and papillomatous. This latter 
condition, when well developed, has been frequently referred to under the 
name of elephantiasis verrucosa. Very early papilloma may be observed upon 
the scrotum in the case illustrated in No. 171. At times in elephantiasis of 
the lower extremities, the closely placed papillomata present a very striking 
appearance, so much so that occasionally the condition might be confused 
with that described as ‘“‘mossy foot.’ Buxton? also illustrates this verrucous 
condition in filariasis in researches in Polynesia and Melanesia. 
1 Stephens and Yorke: ‘Practice of Medicine in the Tropies,” edited by Byam and Archibald 
(1923), III, 1948. 
2 Morenas: Bull. Soc. Path. Exot. (1929), XXII, 325. 
8 Buxton: London School Trop. Med., Memoir Series (1928), No. 2. 
