One advantage of the study of the incidence of tumours among such backward races "new" to civilisation as inhabit New Guinea, is that it becomes possible to consider the value of certain factors which at one time or another have been held to be causative in the production of malignant tumours. For this reason the occurrence of new growths was studied not only in Papuasians but in immigrants of the white and Polynesian races; there being a number of the latter in the Possession imported as teachers by the London Missionary Society.

Owing to the courtesy of Dr. Wendland, Chief Medical Officer at Ralum, New Britain, I am also able to adduce some facts relative to the occurrence of tumours among the inhabitants of New Britain, New Ireland, and the Northern Solomons. Further, a series of interesting venereal tumours were obtained from the native dogs of the Central District of British New Guinea. The natives everywhere have the most extreme objection to surgical treatment, so that the number of cases in which microscopical evidence as to the nature of the tumour is forthcoming is very small. As a matter of fact, new growths, whether innocent or malignant, with the exception of small congenital pigmented moles, were rare.

In the following pages an account will be given of the innocent and malignant new growths met with in British New Guinea and Torres Straits among (1) Papuasians, (2) other Melanesians, (3) Europeans and Polynesians.

BENIGN TUMOURS IN PAPUASIANS.

PAPILLOMATA.—Cutaneous papillomata are common among the natives throughout the Possession, but are, I think, decidedly less frequent than among Europeans. The largest seen was about the size of a cherry, and sprang from the skin on the front of the leg below the head of the tibia, in a boy of about sixteen.

FIBROMATA. I believe that subcutaneous fibromata were not very uncommon, but where there was inflammatory adhesion of the skin, it was not always easy to be sure of the diagnosis, since there can be no doubt that granulomata of an ill-defined nature involving the cutaneous and subcutaneous tissues are common enough. In the following instance it seemed that the diagnosis was reasonably clear :

Hari Kohu, a man aged about 50, of Akorogo village, near Port Moresby, has a swelling immediately in front of his ear, which is somewhat oblong in shape and about the size of a split apricot. It is subcutaneous

and freely movable over the deep structures, while the skin over it is nowhere adherent. It is said to have been present since the man was a small boy and to have slowly increased in size. On palpation it is firm and obscurely lobulated, while pressure upon it produces no pain. It seems too firm for a lipoma, so probably it is a fibroma. The patient refused operation.

LIPOMATA.-Warupi Poni, of Waima, has symmetrical lipomata, the size of a hen's egg, over the outer end of each clavicle. There is also a subcutaneous fibroma, or perhaps an enlarged bursa, over the right acromion and two fibromata or bursæ over the left trochanter, each about the size of a walnut. The patient, who has always been dumb and is partially deaf, is quite intelligent.

A large lipoma sprang from the posterior triangle of the neck of a man of Kiriwina in the Trobriands (fig. 2), in whom it had been present for many years. Although neither of these diagnoses was confirmed by the removal of the tumour, it is impossible that anyone looking at the figure will seriously question the diagnosis of the lump shown in that photograph; while the masses in the case of Warupi Poni, though symmetrical, were really equally typical.

OSTEOMATA.-A case was seen at Delena of multiple small hard masses springing from the lower end of the femur of an apparently perfectly healthy woman, in whom there was certainly no sign of chronic rheumatoid arthritis or other joint trouble. There can be little doubt that post-mortem examination would have shown that these masses were osteomata, and clinically there seemed no reason to hesitate as to the diagnosis.

At Hulaa a man, Vilai Rakava by name, was seen who was judged to be about 50 and had in the region of the angles of the lower ribs on the right-hand side a hard oval mass between 3 and 4 inches long, which apparently sprang from the ribs; it was not movable upon these, but the skin over it was perfectly free. It caused no pain, and was said to have been of many years' duration. It was probably an osteoma or chondroma.

ANGEIOMATA.-At Iwa a middle-aged woman had a large plexiform angeioma involving the vessels of one temporal region and the forehead on the same side. There was no dilation of the corresponding vessels on the opposite side.

CONGENITAL PIGMENTED MOLES and pigment spots are extremely common (fig. 3). I can remember only one subject, a girl of about 12,

in whom a tolerably close scrutiny of the exposed parts of her body did not show pigment-flecks; while of 24 subjects, mostly male, selected at random in the village of Hohodai, 15 had well-marked congenital pigmented moles, in some cases hairy *. This number, equivalent to 62.5 per cent. of the subjects examined, would doubtless have been even larger had the examination of the cases been more complete ; for in no case was the neighbourhood of the genitals examined, while in the women the part of the body covered by the petticoat, i. e. from the pelvis to the knees, was necessarily not inspected. The largest congenital pigmented mole or rather series of moles met with is shown in fig. 3, growing behind and in front of the lobule of the ear of a female dwarf, a native of one of the Hanuabada villages.

In spite of the frequency with which they occurred, no case was seen or heard of in which a pigmented mole gave rise to a large tumour or tended to spread.

BENIGN TUMOURS IN OTHER MELANESIANS.

At Herbertshöhe in New Britain, Dr. Wendland, the Government. Medical Officer, showed me a fibro-cheloid he had removed from the ear of a native. This growth, which was about the size of a small orange with a tuberose surface, resembled those from the ears of natives of the French Sudan, figured in the Journal of Tropical Medicine by Le Dantec and Boyé †. Like many other Melanesians the folk of New Britain bore the lobule of the ear, and as age advances both the lobule and the hole bored in it may become enormously enlarged owing to the habit of carrying small objects in the pierced lobule.

MALIGNANT TUMOURS AMONG PAPUASIANS.

Malignant tumours are especially observed among the natives of British New Guinea. Sir William Macgregor, who was for nearly ten years Governor of the Possession, first drew attention to their rarity in an address delivered at the London School of Tropical Medicine. Sir William said:

"For nine and a half years I never saw a case of cancer in British New Guinea, but at the end of that time there occurred an

* Hohodai is one of the component villages of the large village systems formed by the Port Moresby villages and usually known as Hanuabada.

Journal of Tropical Medicine, May 1901.