— 42 — The affection I have called “ pseudo ” paralysis agitans resembled the disease met with in England, but the tremor affected the whole body, was of a gross character and could not be localised. Further the muscles of deglutition seemed to be affected so that in both cases saliva continually dribbled from the mouth. In both cases considerable amelioration of the condition followed treat¬ ment with Novarsenobillon.

The other C. N. S. affections were all equally interesting, but examination of cerebro-spinal fluids and other laboratory tests will be necessary before the etiology of these conditions can be ascertained.

Vaccination. The numbers of children brought up for vaccinations show how appreciation of medical methods is extending in the tribe, especially considering that much of the area was vaccinated in the preceding year.

Summary. The general health of the Shilluk people has reached a high standard, owing to lack of recent epidemics and inter-family fighting.

The birth rate is definitely on the increase.

The death rate is high amongst children due probably to malignant tertian malaria.

Tuberculosis is a new disease, probably increasing.

Gonorrhoea is prevalent near merakiz, but not likely to spread widely.

Syphilis and yaws. The clinical differentiation between those two diseases is undetermined and a matter for future investigation.

Ulcers are very prevalent and their etiology also requires further investiga¬ tion.

The relation of general bone pains to syphilis, yaws, malaria and rheumatism is not manifest.

Eye diseases form a considerable proportion of the minor ailments which could be satisfactorily dealt with by chiefs' dressers, with elimination of the more distressing sequelae.

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Malaria. There is no doubt that this negroid tribe suffers severely from this disease and that malaria causes a high mortality amongst children. It is also apparent that a degree of immunity is acquired by the time adult life is reached.

Malignant tertian seems to be the most prevalent parasite. Quartan occurs to a less extent and is confined to the Zeraf area.

Leprosy exists, but is apparently on the decrease.

The etiology of diseases of the G.N.S. is a matter of considerable interest.

Conclusions. A system of closer medical attention would considerably improve the general health of the tribe as the bulk of the diseases encountered would readily yield to medical treatment.

The institution of a system of chiefs’ dressers is the most economical way of initiating this.

A properly equipped dispensary should be established at Tonga. It is a very unhealthy division, and acts as a buffer between the Nuer and Dinka and the rest of the tribe. It appears that yaws at least has spread northward from these tribes and with freer intercommunication which is bound to increase, other diseases also might spread in a similar manner.

The control of existing diseases with the probable exception of malaria should not present many great difficulties.