XXIV 
OTHER PATHOLOGICAL CONDITIONS 
UmBinLicAL HERNIA was found to be very common in Liberia. It was fre- 
quently observed in young children but rarely noted in adults (No. 282). Ap- 
parently this condition usually develops from non-resistance of the umbilical 
sears which form after the umbilical cord drops off. The umbilicus then gradu- 
ally becomes mechanically stretched. The hernia is probably especially favored 
by bad management at parturition followed in very early childhood by constant 
distention of the abdomen from eating coarse food. It would appear that many 
of the cases recover spontaneously during or before adolescence, but we cannot 
be sure of this fact. Inguinal hernia was rarely observed. Umbilical hernia was 
much more common in Liberia and parts of Africa than in tropical South America 
or the Far East. I have never observed so many cases on any previous expedi- 
tion. Madden,! in his excellent article, Connor? in his book ‘‘Surgery in the 
Tropics,” and Castellani and Chalmers in their comprehensive ‘‘ Manual of 
Tropical Medicine,” although they discuss inguinal hernia, do not refer to this 
condition of the umbilicus. 
Neoplasms were not found to be common in Liberia. The tumors of para- 
sitic origin have been discussed in Chapter XVII. Several cases were observed 
in which the clinical diagnosis was fibrosarcoma with no evidence of special 
malignancy. The largest of these occurred in a middle-aged negress. The tumor 
was located on the outer aspect of the lower leg in its upper third. It was rounded 
and the size and shape of a grapefruit. The greatest diameter of the tumor was 
14 em. and it projected 6.5 cm. from the leg. Microscopical examination of a 
few drops of fluid obtained by puncture with a needle revealed no parasites. 
The patient refused absolutely to permit excision of a piece of the tissue for 
histological examination. In another instance, in a well-developed and well- 
nourished man, a large mass was found projecting downward and outward for 
about 12 em. below the ramus of the lower jaw. The tumor was not adherent to 
the skin and was slightly movable under the underlying structures. At Kisenyi 
an old woman was observed with a fungating mass at the ala of the nose which 
was apparently a carcinoma. 
Several cases of cystic goiter were seen in Liberia and in the Congo. No 
evidences of hyperthyroidism were obtained (No. 287). 
Intestinal infections. The common intestinal nematodes, Ascaris, Oxyuris, 
Uncinaria (Ancylostoma), and Strongyloides were found (as would be expected) 
' Madden: “‘Practice of Medicine in the Tropics,” ed. by Byam and Archibald, III, 2499. 
* Connor: ‘Surgery in the Tropics,” 1929; also Trans. Royal Soc. Trop. Med. and Hyg. (1928), 
ALL, 219. 
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