6 Congenital Anomalies in a Native African Race 
(7) Obesity. No cases of general obesity outside normal limits with possibly 
a congenital origin have been seen. Steatopygy does not occur. 
(8) Symmetrical Lipomatosis is conveniently considered here though perhaps 
not strictly within the subject. Three old women have been seen all presenting 
the same abnormal feature, namely, the presence of symmetrical lipomata in both 
axillae, each about the size of a small orange. In a fourth case the affection was 
one-sided, the subject giving a history of the gradual descent of the tumour from 
the upper aspect of the shoulder into the arm-pit. 
That tliese tumours were lipomata I can only support by clinical examination, 
they certainly were not of the nature of the pads seen in myxoedema and no 
signs of that disease were present. There is the possibility that they were acces- 
sory breasts but they did not present the characters found in undoubted cases of 
this condition. These tumours may have a similar pathogeny to the masses seen 
on either side of the back of the neck of men and specially described by 
Sir Jonathan Hutchinson ; on account of their possible paleogenetic significance 
I have included notes on these cases here. 
(0) Lymphatism. Post-mortem examination on a boy 10 years of age who died 
after receiving a blow on the head revealed a thymus gland of considerable bulk, 
4 inches loup-. The blow had not severed the soft tissues over the skull and in 
o 
the absence of any other evidence of injury or disease one might suspect the case 
to be one of lymphatism, an inherent disorder which had predisposed to death. 
In a second case, that of a woman aged 40 years who died after moderately severe 
burns, a body 4| inches long of yellow colour and firm consistency was found lying 
on the anterior surface of the heart, the apex of this body being at a level with 
the 2nd costal cartilage. 
(10) Coming now to Malformations, there is a well-defined deformation of the 
skull of which I have seen several examples, the main points of which are well 
shewn in the photographs. The extreme height of the cranium and marked 
dolicocephaly without bossing of the forehead, while the sides of the vault of 
the skull are flattened, are characteristic. The photographs depict a boy aged 7, 
son of Matikwiri, lieadman of Mlanje, whose two younger sisters are said to 
resemble him exactly in the deformity present (Plate IV, (12) and (13)). 
The second case is a boy aged 1.5 years, the head measured 21"5 cm. long and 
12-5 cm. broad (Plate III, (9)— (11)). 
(11) Congenital Ptosis is not uncommon and is associated with the typical 
expression due to this disability. A slight degree of Epicanthus may be fairly 
often observed; moi'e marked, it is sometimes seen associated with obliquity 
of the palpebral fissures giving a regular mongolian character to the face 
(Fig. 3). 
Buphthalmos has been seen on two occasions in young adults with a history of 
its congenital nature but nothing else of note ; tension normal and vision appa- 
rently good. 
