308 REPORT OF THE HARVARD AFRICAN EXPEDITION 
were vaccinated, Dr. Willis, the physician in charge of the Firestone Planta- 
tions Company having arranged with us to perform these vaccinations. The 
pitted scars of smallpox are not uncommonly seen on the faces of natives of a 
number of tribes in the interior. Chickenpox was also observed in children 
in Liberia (No. 284). 
At Lisala in the Belgian Congo a patient was observed with advanced 
tubercular leprosy who was also suffering with a well-developed exanthem of 
alastrim. Several other cases of alastrim were also seen at Lisala. 
Tuberculosis and gonorrhoea are also among the cosmopolitan diseases com- 
mon in Liberia. The former is not uncommon among the Americo-Liberians, 
but is apparently not prevalent among the tribes inland. Dr. Shattuck observed 
only one case of phthisis in the interior of Liberia which gave signs ordi- 
narily present in advanced cases. Phthisis was said by the Government physi- 
cian at Kinshasa to be very prevalent in the surrounding Belgian Congo, and 
that its prevalence in natives in the interior was directly proportional to their 
contact with whites. Dr. Shattuck thinks that it is probable that, as time 
goes on, phthisis will become far more prevalent among the natives in Africa 
than it is today, and that it may eventually cause a very high mortality. He 
thinks that it is not unlikely that a similar expansion of tuberculosis from the 
inhabitants of the coast to the tribes of the interior may be anticipated in Liberia. 
Gonorrhoea was particularly common among the people residing along the 
coast in Liberia and in those who had come in contact with them, but among 
the more isolated tribes of natives in the interior only one case (No. 353) of 
gonorrhoea was positively diagnosed by microscopic examination of the dis- 
charge. No cases of gonorrhoeal ophthalmia were seen among native children. 
Old lesions of the eyes, which were not infrequent, were apparently usually 
due to accidental injuries. 
At Gbanga, where a number of men thought they were ‘‘woman sick,” 
bilharzia ova were found in the urine. 
Buboes, unilateral or bilateral, were occasionally encountered, but chan- 
croid, funiculitis, and hydrocele were rarely seen, while no typical case of granu- 
loma inguinale was observed by us in Africa. 
Dr. Shattuck found circulatory diseases scarce in Liberia. Typical cases 
of valvular disease of a rheumatic type were not met with, neither was a single 
case of the luetic type of cardiac disease nor of aneurysm recognized. More- 
over, hypertension was not observed and peripheral arteriosclerosis was rarely 
noted.» However, in one old woman marked sclerosis of some of the veins of 
the leg was observed. The few cases of cardiac insufficiency that were seen 
corresponded to no definite type of valve lesion. He thought that treponemi- 
asis might perhaps have been the cause of such myocardial weakness. Nephri- 
tis was also found to be uncommon. 
Acute rheumatic fever, like typical rheumatic heart disease, was not observed 
in Liberia. Cases of arthritis were not uncommon but they were of types that 
suggested either gonorrhoea or treponemiasis as the cause. In some instances, 
the cases of gonorrhoeal arthritis were typical, the gonococcus being obtained 
