Distribution of Tropwal Diseases in Africa. 437 
is very common. Tropical ulcers are very frequently seen ; 
they occur chiefly in the debilitated natives, and cause great 
havoc in the slave caravans. Diarrhcea prevails extensively. 
Dysentery is extremely common throughout the whole of the 
area, especially at Zanzibar. Epidemics of dengue are of 
frequent occurrence. Although, as has been mentioned, 
phthisis is not met with in East Africa, yet pleurisy and 
bronchitis are very common. Typhoid fever is fairly 
common. bBeri-beri also exists in East Africa, and it is 
probable that the epidemic dropsy which is mentioned by 
Livingstone was really this disease. Throughout all Kast 
Africa malarial fevers are very rife; they are most severe 
upon the coast, along the river valleys, and in marshy, water- 
logged areas; in fact they are met with wherever the 
factors known as those producing malaria exist. To these I 
shall refer subsequently when dealing with the prevention 
of the disease. It should be noted, however, that the fevers 
on the table-land are much less fatal in character than those 
met with upon the coast, and there are areas over 2500 feet 
in altitude, where it may be said that the incidence of 
malaria is of but slight import. It may be well to mention 
here that the reason why East Africa has such an evil repute 
owing to the many deaths which have occurred amongst the 
Europeans who have visited it, is due to the fact that these 
explorers and missionaries have been compelled to make a 
long stay on the coast before proceeding inland, and have 
there become saturated, as it were, with the malarial poison. - 
Were these conditions rectified, and were it possible for the 
whites to proceed rapidly to the interior, there is no doubt 
that their general health would be far better, and it is for 
this reason that for the last ten years I have so strongly 
advocated the construction of short railways to carry 
travellers rapidly across the malarious belt on the coast. 
IV. West Coast OF AFRICA. 
The west coast of Africa from Cape Verd to Cape Frio, is 
the hottest and wettest region in the globe, probably the 
most unhealthy too. The expression, “the white man’s 
