354 Anomalies of Pigmentation among Natives of Nyasaland 
commenced as a very small patch on the right shoulder which has never spread. 
Now spots are seen on the body, face and limbs (Plate XII, Fig. 3). 
He states that a patch appears very quickly, in a few days reaching its 
maximum size and that the extremities are the last to become involved. At 
the present time the middle two-thirds of the red margin of the lower lip are 
affected, there is a patch on the right side of the filtrum of the upper lip, some 
small areas over the left shoulder, three patches the size of a half-penny over the 
upper part of sternum, a few points over the chest and abdomen in front and on 
back ; the arms from the elbows downwards are the seat of large patches ; the 
wrists, thumbs, dorsum and palm of hands and fingers also show patchy depig- 
mentation ; patches on the left knee, the dorsum of the feet and toes, and over the 
ankles are also present. 
These affected areas are of a pink colour as of a fair European skin ; they are 
in some places a little crusted. 
There is a lack of signs of slow depigmentation, that is, areas of all shades of 
dark brown to pink are absent. In association with some pink areas there is a 
surrounding hyperpigmentation ; these the boy states were previously depigmented 
and pink. This phenomenon was well seen on the arms, the leucotic areas pre- 
senting black hairs as on unaffected skin. Affected areas over the manubrium 
sterni, though there is no hair on the surrounding normal skin, present hairs 
which are black. No one else in the family affected. 
Under the name of " Melung " (Beta), Ziemann has described in the Archiv fur 
Dermatologie and Syphilis, Bd. Lxxiv. S. 163 — 170, Wien und Leipzig, 1905, a 
skin disease among negroes on the West Coast of Africa " characterised by 
the appearance of round, oval or irregular shaped patches of a bright yellow 
red colour on the skin of the extensor and flexor surfaces of the hands and 
feet." Here in Nyasaland I have seen a number of cases which correspond 
more or less with the descriptions given by Ziemann, but there are several 
points of difference, and I am inclined to think that that observer has made 
too hard and fast limits for the type of leucoderma which he has described. 
He says, " The predominant colour of the affected areas is of a whitish tinge and 
the general aspect may be compared to that of extensive superficial burns which 
have healed without the formation of granulation tissue. The disease begins at 
the age of from 10 — 15 years; its course is symmetrical, either attacking the 
hands first and then the feet or the feet first and the hands afterwards, or both at 
the same time. The progress of the disease is extremely chronic." He further 
notes that never more than four-fifths of the surface of the hands or feet are affected 
with pigment atrophy. The flexor surfaces are more extensively involved than the 
extensor, the pigment atrophy is practically confined to the hands and feet, only 
further slight extensions occur after 10 — 20 years and there is gradual loss of 
pigment in the hairs situated in affected regions. Sensibility to touch, tempera- 
ture, and pain and muscle sense are unimpaired ; the sweat glands are normal ; 
