SPECIAL PROTOZOOLOGICAL STUDIES OF THE BLOOD 497 
three specimens would be present, at the base of the gland, flattening out the 
epithelium and producing a bottle-like swelling of the gland. 
HUMAN TRYPANOSOMIASIS IN LIBERIA 
This disease seemed to be fairly well known by the natives of the interior of 
Liberia. In the Vai language sleeping sickness is known as konje-kira, which 
literally translated is ‘ball sickness” 7.e., enlarged lymph glands. No doubt 
many cases of enlarged cervical lymph glands are called konje-kira though not 
due to a trypanosome infection. Indeed, several cases in which the enlarged 
lymph glands were in all probability caused by a pyogenic infection of the scalp 
were brought to us as cases of konje-kira. 
Doala Bukere, the originator of the remarkable Vai alphabet, is supposed to 
have died of this disease (Johnston, “ Liberia,’ vol. II, p. 1114). He developed 
such extraordinary drowsiness that he often fell asleep while taking his meals. 
In the Kpwesi dialect the malady is called ptauli. 
Typical early cases of trypanosomiasis were seen in Bakratown, Nyalai, 
Betala, and Paiata. Although strenuous efforts were made to find as many 
cases as possible, only ten cases which were probably trypanosomiasis were found, 
in five of these the diagnosis was confirmed by finding the causative organism by 
gland puncture. It is often very difficult in primitive native villages to obtain 
the confidence of the population. This was, however, not the case when we were 
searching the country for cases of sleeping sickness. In fact we had very hearty 
cooperation from the native chiefs, who did their best to locate the cases for us 
and sometimes walked many miles with a patient. All our cases were in the 
early stage of the disease. We saw no ease in the later stages. The explanation 
for this is probably due to the fact that when a native becomes very ill he prefers 
to call in his own medicine-man. This is particularly so in the interior of Liberia 
where the population has not been in contact with the white man and has there- 
fore no faith whatsoever in his “medicine.” | 
Case A. 6. Bakratown. Boy about eleven years old. Complained of head- 
ache and enlargement of glands. All palpable lymph glands enlarged. The 
posterior cervical lymph glands fill out the back of the neck. Anterior cervical, 
submaxillary, supra-clavicular, axillary, epitrochlear, inguinal and femoral lymph 
glands enlarged. Spleen enlarged to an inch below the costal margin. Examina- 
tion of fresh blood showed auto-agglutination of red blood corpuscles, but no 
trypanosomes were seen. 
A stained blood smear revealed an infection with subtertian malaria. 
Puncture of posterior cervical gland showed numerous trypanosomes. 
Case A. 20. Boy, seven years old. Patient lives in the village of Nyalai. 
Posterior cervical, submaxillary and axillary lymph glands enlarged. 
Examination of fresh blood showed auto-agglutination but no trypano- 
somes. The diagnosis was established by the finding of numerous trypanosomes 
by puncture of the submaxillary lymph gland. 
Case A. 24. Girl, about 17 years of age. Betala. Enlargement of posterior 
cervical lymph glands, otherwise normal. Gland puncture showed trypanosomes. 
