442 Proceedings of the Royal Physical Society. 
often spread with extremely fatal results amongst the native 
population. Very few cases of cancer are met with on the 
west coast of Africa, but tropical ulcers are extremely 
common. 
With regard to hepatitis and tropical abscess of the liver, 
there is considerable variation in the occurrence of these 
diseases, both amongst white men and natives. For instance, 
hepatitis is extremely prevalent amongst the whites in 
Senegambia, but is not often seen amongst the natives. 
It is comparatively rare in the Niger district, but is more 
frequently met with on the Congo coast. On the whole, 
tropical abscess of the liver is less frequently seen than one 
would expect, and it would appear to be a sequel to severe 
attacks of dysentery. This statement, however, should be 
taken with caution, as if it is true it is very different from 
what usually obtains in India and other tropical countries. 
Whooping-cough is said to occur in Senegambia, but I have 
seen no account of it elsewhere. 
Amongst the native population over the whole west 
coast of Africa, skin diseases are common. Insanity is 
not frequent, but tetanus often occurs, especially amongst 
children. Rickets are comparatively rarely seen. 
Anemia is invariably found in Europeans throughout 
the west coast of Africa, and is usually due to malaria; it 
may however be due simply to residence upon the coast. 
Guinea-worm is especially frequent between Senegambia 
and Cape Lopez. In Senegambia it is met with not 
only on the coast, but in the more elevated region which 
extends from Bakel to Galem, though the parasite does not 
infest the banks of the Casamance. The Sierra Leone coast 
is less extensively infected by the guinea-worm than the 
Grain Coast, Ivory Coast, Gold and Slave Coasts. It is met 
with throughout the Niger district, and also in Gaboon. 
It is to be noticed that on these coasts various places, such 
as Cape Coast Castle, Elmina, Cormantia, ‘and Accra, are 
especially affected, whereas the surrounding country very 
often is free from the parasite. I do not believe that there 
is any connection between guinea-worm and Llephantiasis 
arabum. / 
