440 Proceedings of the Royal Physical Society. 
stated that typho-malarial fever occurs there, in all prob- 
ability it does exist; for as I shall point out subsequently, 
I am convinced that typho-malarial fever does not exist as 
a disease per se, but that in all cases where typho-malarial 
fever is reported we are really dealing with patients in whom 
both typhoid fever and malaria are present. 
Diarrhoea and dysentery are extremely common in Sene- 
gambia, being most frequently seen from September to Nov- 
ember; also prevalent to a slightly less extent in December, 
January, and February. Both diseases occur also in endemic 
form in Sierra Leone; they are however not quite so 
frequently met with as elsewhere. Diarrhcea is often met 
with on the Gold Coast, but dysentery is more rarely seen, at 
any rate among the Europeans. Both diseases occur at 
Lagos, as also with extreme frequency in the Niger district. 
Diarrhea is very common at Gaboon, but dysentery, although 
endemic, affects the natives chiefly. Probably the diminu- 
tion of cases amongst the white residents is due to sanitary 
precautions. On the Congo coast diarrhcea prevails, as also 
dysentery, but this disease is not nearly so frequent as in the 
Upper Congo district, to which reference will be made later 
on. In Angola, diarrhcea is fairly common, but dysentery 
is more rarely seen, and when it occurs it is chiefly after the 
rains. 
Severe epidemics of dengue occur in Senegambia, but 
curiously enough that is the only place on the west coast 
of Africa where this disease obtains. Cholera visited 
Senegambia in 1868, but has not been recorded as occurring 
elsewhere on the west coast of the continent, although we 
do find scattered notes referring to sporadic cholera on the 
northern part of the west seaboard. Now in 1893 cholera 
is again ravaging Senegambia. 
Beri-beri is very prevalent in the Congo district near the 
coast, as also is a disease called the sleeping-sickness or 
negro lethargy, a disorder which has a rather wider distribu- 
tion, namely from Senegambia to this district. It is at 
present a moot question whether these two diseases are 
identical. It is also thought by some that both diseases are 
really due to the Anchylostoma duodenale, aud if so they 
