22 
Congenital Anomalies in a Native African Race 
It would appear that 
(1) The slighter the anomaly the greater the frequency with which it may 
be observed. 
(2) The more marked degrees of deformity are only seen in children and 
those in places where European influence is felt. 
(3) Cases of heredity are only seen among the lesser anomalies. 
(4) The least obvious congenital anomaly is a helical fistula, and this is 
found in 4*6 % of the population and is frequently inherited. 
The difference in the observed incidence between the minor anomalies and 
those of more marked proportions may be real or only apparent. I think the 
latter supposition is true for reasons which can be deduced from the facts given 
above. 
It is the custom among all the tribes of this country to destroy all deformed 
children at birth. Any minimal deformity such as a helical fistula is of course 
unrecognised, an accessory nipple is probably hardly noticeable, accessory digits 
which can be removed by a nick with a knife are matters of no import, while a 
foot with six well-formed toes would hardly be considered worthy of note. These 
abnormalities are therefore comparative!}' common, but hare-lip, cleft-palate, 
deformities common enough in Europe, are among the rarest in this country ; a 
child with a hare-lip would be seen to resemble a hare and would be immediately 
destroyed. Children with the greater deformities would certainly be destroyed. 
In recent years under European influence native customs fall into abeyance and so 
we see my single case of hare-lip in a boy aged 10 at Blantyre, a township of 25 
years standing, a child with gross deformities of the lower extremities born prac- 
tically on a mission station ; or, to quote another example, an albino reported by 
myself was the fifth albino child born, the first four having been killed at birth 
by order of a chief, who in later years came under the influence of an up-country 
mission station, for which the living albino has to thank his survival. The gross 
abnormality of absence of premaxilla would pass unnoticed as the deformity is 
slight. History relates that in the case of the child with lobster claw deformity of 
hands and feet, it was only saved from a summary death by the efforts of the 
mother. 
I think with the evidence as it stands one may with fairness say that con- 
genital anomalies are common among the natives of this country. Secondly, I 
think one may also deduce from the facts .stated that abnormalities of all kinds 
are at least not uncommon. In the few cases in which I have adduced statistics 
there can be no doubt, in other cases it is rather a matter of one's impression. 
I have shewn that certain congenital anomalies among natives of Nyasaland 
are common and have attempted to argue that probably many of thera are 
common. 
