360 REPORT OF THE HARVARD AFRICAN EXPEDITION 
in the urethral discharge. A case of infective arthritis of doubtful origin was 
also seen. 
Diseases of the nervous system were not often found in Liberia. Tabes and 
general paralysis were not observed. A single case of probable Parkinson’s 
disease and several cases of probable poliomyelitis were encountered in Liberia, 
and several cases of the latter were seen also in the Congo. Syphilis of the 
central nervous system, which was observed in parts of the Belgian Congo, 
has already been referred to (page 281). A few cases of hypochondriasis, of 
neurasthenia and of hysteria were also met with among the natives in the 
interior of Liberia. 
Many eases of emaciation were observed in Liberia, which condition, so 
far as we could ascertain, was frequently independent of infectious chronic 
disease. The diet of many of the natives in the interior is not one upon which 
a white man would probably long survive. The great scarcity of meat has 
already been referred to. Mandioca root, palm oil, rice, and bananas (quite 
green), are staple articles of diet when obtainable. Many of the cases of emaci- 
ation were undoubtedly of dietetic origin (No. 285). In other cases of ema- 
ciation the difficulty seemed to be due especially to poor teeth and inability 
to masticate the rough, coarse food. We were told in the interior that when 
a man’s teeth became so poor that he could not eat the coarse native food it 
was about time for him to die. This view was to some extent confirmed by 
the relative scarcity of elderly people in the interior, and by advanced emaci- 
ation in many of them. Case 382 (No. 286) appears to be a case of chronic star- 
vation largely due to lack of teeth. The patient was a negress of the Gio tribe. 
She seemed intelligent and alert and was well-developed in spite of extreme 
emaciation. She walked with a stick because of weakness. The mucous mem- 
branes were slightly pale and there was chronic iritis of the left eye. There 
were no teeth. The lymphatic glands were palpable but not enlarged. The 
pulse was slightly rapid, becoming more so on walking, when the heart impulse 
then became greatly increased in intensity and could be seen and felt in the 
sixth space of the anterior-axillary line. The pulmonic second sound was much 
accentuated. There were no murmurs. ‘The lungs showed slightly tubular 
breathing and slight dullness with a tympanic quality, at the lower left back. 
A very few rales were heard at the base. The abdominal examination was 
negative. The liver and spleen were not palpable. Knee jerks were present. 
The blood examination for filaria and trypanosomes was negative. <A thick 
smear of the blood showed considerable variation in the size of the red cells. 
The achromia was marked. No blasts were found and the leucocytes appeared 
to be normal in number and appearance. The emaciation could not be satis- 
factorily explained except upon the basis of gradual starvation from lack of 
nourishing food. Dr. Shattuck observed in Monrovia, a case of incrustation 
of the teeth which in his experience was unique in degree (No. 288). The 
lower incisors had become the shape and size of small dice. They were flat 
on the front, back, sides, and upper surface and there was marked pyorrhoea 
which had caused them to become loose. The patient, unfortunately, was 
