18 Congenital Anomalies in a Native African Race 
upwards by the pressure inwards of the fifth toe. The condition is sometimes 
unilateral sometimes bilateral." He adds that in one case the second metatarsal 
and, in another, the third metatarsal were also shortened. In a single case he 
saw a similar condition in the hand, shortening of the second and fifth meta- 
carpals. 
The above description corresponds exactly with the condition seen in this 
country. I have also seen other toes than the fourth affected, and I shew a photo- 
graph of a man's feet with involvement of the metatarsal of the hallux ; in 
another case the fifth was affected ; in another case, a woman, the common variety 
was associated with shortening of the third metatarsal of the left foot (see Plate VI, 
(22), (24) and Fig. 12). 
Fig. 12. Fig. 13. 
(22) Syndactyly of various degrees has been observed ; sketches of two 
examples are given in Fig. 13. 
(23) Polydactyly is not at all uncommon. I have casually come across some 
dozen cases in five years. 
In the majority the supernumerary digit consists of a miniature phalanx 
attached to the skin of the hand or foot at the level of the head of the fifth meta- 
carpal or -tarsal bone. Such digits are often removed in childhood, leaving 
a small cartilaginous nodule at the seat of removal. Most commonly it is a 
symmetrical affection of both hands and feet ; in other cases hands or feet alone 
(Plate VI, (23)), or one extremity only, present the deformity. In some the 
accessory digit is well formed and an accessory metatarsal or metacarpal bone 
more or less complete is present. In one case it was the hallux which was 
reduplicated, the two digits being partially fused. In another, reported to me, 
the supernumerary digit in each hand was situated on the radial side of the 
first finger with probably an accessory metacarpal bone in connection with it. 
The feet bad extra digits beyond the fifth toes. 
(24) The following case is of some interest : 
Chibisa, male, an Angoni of Kawenga's, aged 30 years. The deformities in- 
volve all segments of the right upper and lower limbs and to a minor extent the 
