COLLES'S FRACTURE *

the accepted principle of indirect rule involves the education of the chiefs and people to develop their own service -political, educational, and health-under the advice and guidance only of the European staff, and direct action taken by an energetic European sanitary staff in a native city may entirely destroy the delicate growth of a system of responsibility thrown upon chiefs, sub-chiefs, ward heads, and family heads, quite apart from the inherent difficulties of house inspection among a Mohammedan population. It must also be realized that a campaign against yellow fever alone will receive small support from a native population which is not impressed with the seriousness of the disease, and that the medical authorities in West Africa must face such serious diseases as smallpox, yaws, sleeping sickness, relapsing fever, leprosy, guinea-worm, and schistosomiasis, for the control of which organized campaigns undertaken by survey parties followed by treatment parties are necessary. Some 56,000 cases of yaws alone are being treated each year in Nigeria, anid between 5,000 and 10,000 cases of sleeping sickness. An enormous expansion of health work among the population is taking place in West Africa, and in Nigeria this is becoming more and more effective through the native administrations, which are now entirely supporting eight large hospitals and 140 dispensaries, and are producing well-educated candidates for training as sanitary inspectors, dispensers, and medical assistants. Native administrations are also becoming more and more anxious to install pipe-borne water supplies into their cities. It will be generally agreed that the right way to attack yellow fever is to improve general sanitation and to educate the local population. The programme which we are attempting in WVest Africa is upon the following lines: