202 REPORT OF THE HARVARD AFRICAN EXPEDITION 
male, and by the very great size of the spicules. He also emphasizes the fact that 
in African infection the nodules occur only in about one per cent on the scalp, 
whereas in Guatemala they are almost invariably so located. 
Among the pathological effects of Onchocerca caecutiens noted by Robles and 
the other Guatemalan physicians are photophobia and failure of vision, and 
iritis, keratitis and conjunctivitis, also the condition known as Hrisipela de la 
Costa. The last, according to Robles, is a kind of myxoedema of the skin. It 
begins with the usual appearances of acute febrile erysipelas but involves in the 
majority of cases only the face and head. In the chronic stage, a hard elephanti- 
asis oedema of the skin develops which is often eczematous and of a livid greenish 
color. Filleborn,! who made a brief visit to one of these Guatemala plantations 
where about seventy per cent of the natives were infected, was not able to confirm 
these observations with reference to the symptoms and pathological conditions 
referred to. He found no morphological differences between Onchocerca volvulus 
and Onchocerca caecutiens, nor any differences in the anatomical details of the 
microfilariae of the two parasites. He, however, found the microfilariae of Oncho- 
cerca caecutiens in the blood taken in the usual manner from the patient’s ear- 
lobe and in the blood obtained by venipuncture, as well as in the connective 
tissue of the skin. 
Castellani ? who has also observed this condition in Guatemala at the same 
time as Filleborn, says that in his opinion the eye symptoms and coastal ery- 
sipelas are connected with the nodules and the Onchocerca. Of the eleven cases 
Castellani saw in Guatemala with Dr. Calder6én, all showed in various degrees 
the eye symptoms already referred to. Castellani was inclined to believe that 
the two conditions, West African and Guatemalan onchocerciasis, although very 
similar are not identical. 
Larumbe and Hardwicke * have recently reported cases of onchocerciasis, 
‘blinding sickness’”’ from Oaxaca, Mexico, with ocular symptoms which were 
relieved by incision and evacuation of the cyst contents and parasite. 
We did not, ourselves, meet with Onchocerca tumors about the sealp in Africa, 
though Brumpt * who has had a wide experience with this condition, states that 
the tumors occur in Africa and in the Congo in one per cent of the cases. 
Neither Simulium damnosum nor Onchocerca tumors are as prevalent in 
Liberia as they are in certain other parts of Africa; for example, localities in 
Sierra Leone and the Belgian Congo. 
1 Fiilleborn: Intern’! Conf. on Health Problems in Trop. America, United Fruit Co. (1924), p. 241. 
2 Castellani: Jour. Trop. Med. and Hyg. (1925), XXVIII, 3. 
’ Larumbe and Hardwicke: Trans. Royal Soc. Trop. Med. and Hyg. (1928), XXI, 495. 
4 Brumpt: ‘‘Précis de Parasitologie’’ (1927), p. 757. 
