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desquamating, and, in children a vesicular papular eruption is occasionally met with. As I have seen these conditions in people not suffering from trypanosomiasis but from other ailments, I have come to the conclusion that they are due to these trypano- some-infected people becoming careless and dirty and neglecting their toilet.
Glands. Though I have frequently met with enlarged glands due to various causes, when examining natives, I think that the consistency of the glands in cases of trypanosomiasis is very characteristic. I shall here mention what I found most typical. Cercical glands.--A chain of glands running up on each side of the neck, the shape of hazel nuts large below, becoming smaller as they were followed upwards. On palpating them they felt like balls of pure rubber. I have frequently found the glands between the sternomastoid and clavicle irregular in outline and flattened from before backwards, due, I suppose, to their increasing in size under pressure. Occasionally only one or two were found to be enlarged, but the consistency I have always found the same. I have seen several cases of the disease in the late stages where the enlarged glands had returned to normal size, and I have frequently noticed the disappearance of enlarged glands under the influence of atoxyl.
Cerebral Signs. These vary considerably in different individuals and range from mild excitement to acute mania, delusions being common. In fact, the best description I can give is that the objective symptoms caused by the trypanosome here simulates to a degree the objective symptoms in G.P.I. following the Treponema Pullida. There is one point I should like to mention, and that is the possibility of cases of trypanosomiasis finding their way to a lunatic asylum or a prison. I have seen cases which, if an asylum were convenient, I would have advised their removal thereto, and I have also seen four cases of people convicted for stealing who were really suffering from kleptomania due to trypanosomiasis.
Divisions.
Berekum Division.-The country in this division consists of forests in the south breaking into occasional patches of orchard country in the north. This division, according to the census return, has the largest population in the province, namely, 20,374. Í examined 12,494 people; found 27 new and 14 old cases. The Berekums proper, those are the people living in Berekum and the adjacent villages, are sup- posed to have come from near the Volta River; they were driven into Gaman by the Coomassie Ashantis and allowed to return later. The inhabitants of the two villages, Fiapre and Nsoatri, on the main road between Sunyani and Berekum were originally brought down from Gaman by the Coomassie Ashantis and allowed to build these villages. Cases of trypanosomiasis are always present in them. The Bechens came originally from Akim: they were taken captives by the Ashantis and settled in Bechem. It will be seen from the foregoing that the natives of Berekum Division are rather mixed; but on the whole, I should say they are closely allied to the Coomassie Ashantis. Of course, there are numbers among them who are the descendants of north country slaves. It is often difficult to find them out, their pride preventing them from admitting it. Glossina palpalis, Longipalpalis, Palli- cera, Fusca, and Nigrofusca are all found in the division.
Ahafo Division. This division is covered with dense forest, small clearings are only to be found where there are villages and farms. The inhabitants are of Ashanti origin. The census gives the population as 7,042. I examined 6,972 people and found two cases of the disease. One of those infected was a trader passing through he was a native of Banda in the Northern Province of Ashanti; the other was born in the division, but I am unable to give his family history. Only six cases of disease have been discovered in the division since this investigation started in 1910. All six cases were found in villages on the main road. The number of north country natives passing through this division is much less than through any of the other divisions in the province. Tsetse flies, though very scarce when I visited Ahafo, are to be found all over the division during the rains, as will be seen in Dr. Kinghorn's report.
Wenchi Dirision.The country is divided into forest in the south, and orchard bush in the north. The natives have no knowledge of their origin except that they came out of a hole in the ground near Nquansia, a town in this division. They seem to be ancient settlers and are closely allied to the Coomassie Ashantis. Population; 5,168. Number of people examined this year, 3,232. I found 12 new and 2 old cases. This includes the zongo which I shall speak of later. In 1910 and 1911 there were more infected persons found in Wenchi than in any other town in the Province. This is probably due to the large zengo which is beside Wenchi Town,
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in which are constantly to be found numbers of north country trypanosome carriers. With these numerous trypanosome carriers constantly in Wenchi Town more flies are liable to become infected, and so more of the susceptible ones in Wenchi are liable to become infected than in other villages where no zongo exists. I am glad to be able to state that only two fresh cases were found there this year; one was a north country slave woman, and the other a small boy, a native of Wenchi. This might possibly be due to the susceptible ones being gradually weeded out. Tsetse flies are to be found all over the Wenchi Division, and palpalis are numerous in Wenchi Town and especially at the water supply. Cattle are always to be seen in Wenchi zongo, a herd of Gaman cattle is kept there constantly, and north country cattle are frequently passing through.
Tekiman Division.--This division is situated principally in orchard bush with belts of forest running along the watercourses. The Tekimans have no knowledge of their origin, except that they came out of a hole in the ground near Nkoranza. They were driven into Gaman for a time by the Coomassie Ashantis. The Tekimans are closely allied to the Ashantis, and, like the other divisions, have had their supply of north country slaves. The population, according to the census, is 7,016. I examined 6,046, and found 12 new cases in Tekiman, including the zongo, and 4 in a town named Accumadang on the main Tekiman-Coomassic road. This town, I under- stand, is in the Central Province of Ashanti, but as I visited it when travelling to Tekima, I have included it in my Tekiman returns. Eight of the sixteen persons found are north country natives; two gave a history of north country slave ancestors. One was a native of Sierra Leone, who was also affected with leprosy, and five were natives of Tekiman. Any of these Tekiman natives found infected in villages off the main road had lived either in Tekiman Town or Wenchi Town for some time. Dr. Kinghorn found two cases of the disease in Boyem in 1910; both are now dead, the mother of one of these was a north country slave. I was unable to get the family history of the other. Both of these two cases found infected in 1910 spent most of their time trading in Wenchi, and it is likely they received their infection there. This increase in the number of affected people found in Tekiman is due, I believe, to the large zongo which is rapidly springing up in Tekiman situated 600 yards from Tekiman, and, consequently, the larger number of north country natives to be found in the division than heretofore. Herds of Gaman cattle are a frequent sight in the Tekiman villages. Tsetse flies are found all over the division, palpalis in the neighbourhood of the forest belts, therefore, near the towns and villages, long, pal- palis in the orchard bush. The division, like the others, has had its supply of north country slaves.
Wam Division. –The division is situated principally in forest country. The inhabitants are supposed to have come originally from Akom, near the Volta River, and settled in Boma; they were driven into Gaman by the Coomassie Ashantis, but were allowed to return and settle in Wam. Many of them are said to have come from Sefwhi, in the Colony. The population, according to the census, is 5.271. examined this year 3,176, and found eight cases of the disease: seven of these cases were found in towns and villages on the main roads, the eighth case in a village a short distance from the road. Four of the persons found infected were north country slaves, one was the daughter of a north country slave, and three were said to be natives of Wam. Tsetse fires. According to native evidence, these flies are all over the division. I found palpalis in Nchira and Dr. Kinghorn found them in Pamu. This division has had its supply of north country slaves.
The
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Gaman Division.—This division is situated in the north of the province, prin- cipally in orchard country, and the further north the more open does the orchard country become.
Forest belts are found along the watercourses. The Gamans appear to be ancient settlers. Parts of Gaman were overrun by the north country slave-raider Samori, and hundreds of these Gamans, principally from French Gaman, were sold as slaves to the Ashantis in the Bontukn slave market. original settlements in this division appear to be Sikasiko, Debibi. Duodaso, Kukwang, Jambera, and Brodie. The inhabitants of Saikwa came originally from the Ivory Coast. Drobo and Nsokor appear to be of later origin than the others. The Drobos are supposed to have come out of the same hole in the ground as the Wenchis, but during some war were driven into Gaman, where they settled. Though these Gamans suffered from Samori's slave-raids, they seem to have procured numbers of north country slaves for themselves, with whom they inter-married, and I should think the north country element in them is fairly strong. The population of Gaman,
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