350 Anomalies of Pigmentation among Natives of Nyasaland 
shades of brown present. Round the areas in which the change has taken place 
there is hyperpigmentation more or less marked, in some areas the skin being 
absolutely black. There is a worm-eaten appearance on the palms of the hands 
which the man states is the result of yaws in boyhood. There is also compound 
ganglion affecting both wrists. The photograph (Plate XIV, Fig. 10) illustrates 
rather poorly these features. 
Mundana. Male, aged 40, of Chikumbo, Mlanje, Makua. 
Patient states that the affection of his hands and feet was present at birth, and 
has not altered since. This I think is very doubtful and probably one may infer 
that the disease began in very early childhood, and has not progressed of late 
years. He says he has not suffered from yaws. Both hands and feet are affected, 
the former to a small degree and the feet still less, so that it is hardly noticeable 
in the latter. 
There are only two or three small areas actually pink, for the most part the 
colouration is patchy and of various shades of brown to orange. The process has 
involved the hands and fingers, the wristband area and the dorsum of the foot and 
toes on both sides. 
There is a hyperkeratosis of the palms of the hands and of the skin of the 
extensor surfaces of the interphalangeal joints. The palms of the hands also 
present a worm-eaten appearance with the formation of little pits. There is 
likewise heaping-up of epidermis with cracking at the flexures on the palms. The 
hairs on the extensor surfaces of the fingers have fallen out, leaving little pits. 
Y. Male, aged 40. A Swahili from Zanzibar, Range Capitao, Zomba. The 
hands only are involved, but in a perfectly typical way. The disease is stated to 
have commenced when the subject was a small boy. 
Other cases have been seen but of them no notes have been kept. In discussing 
the relation of these cases to ordinary leucoderma it must be remembered that 
natives are seen with a similar patchy speckled depigmentation process affecting 
the skin of other parts than the hands and feet. Thus I have seen a condition 
along the middle line of the back or in the middle of the chest on several occasions. 
In the case of a girl I., aged 10 years, mentioned above, it was associated with 
similar speckled condition of the fingers, and was said to have been present at 
birth. Chisfufu, as will be seen by a glance at the sketch on Plate XX, not only 
had a typical affection of the hands and feet but the process also involved the 
trunk, all four limbs and the lips. 
While it is true that there is a large number of cases of an "imperfect" 
leucoderma corresponding more or less to the description given by Ziemann, 
I find that there are many others in which the process is wider in its distribution 
and which are therefore connecting links between the type described by Ziemann 
and ordinary leucoderma. Even in such cases of long standing the areas involved 
are of small extent, and it is but seldom that one would see a portion of skin of 
