Goundou.—In goundou the nasal bones and the nasal processes of the superior maxilla are the seat of symmetrical swellings of the nature of an hypertrophic osteitis. These exostoses may be quite large so that there is interference with vision. There is little or no pain connected with the bony growths and there is no invasive tendency.
Big Heel.—There has been observed in natives of the Gold Coast an affection of the os calcis somewhat like that involving the superior maxillary bones in goundou. The disease begins with pain and tenderness of one or both heels. The enlargement may involve only one os calcis or affect both bones. There is no joint involvement but locomotion is interfered with. There are periods of improvement which are followed by return of the pains.
Ainhum.—In this disease there is thinning or absorption of the bones of the toe. A fibrous cord replaces the bony structures.
Oroya Fever.—In this very serious disease of certain areas of Peru the bone pains may be excruciating. These bone pains are especially marked in the sternum but also involve the long bones.
Trench Fever.—Pain over the shin bone is a prominent complaint in this affection so that the term “trench shin” has been employed.
Relapsing Fever.—Bone pains, especially referred to the knees, are complained of by patients with the bilious typhoid of Griesinger. This is a type of relapsing fever occurring in Egypt.
Leprosy.—The bone affections of leprosy are considered under the muscles.
Muscle Involvement
Leprosy.—In this ancient disease the course of which is marked by anaesthesia, atrophy, absorption and accidents (cigarette burns, etc.), the lesions of bones, joints, muscles and indeed of all other tissues are, in great part, due to infiltration of nerves by the organism of leprosy. The effects are secondary and trophic on the one hand, and on the other partly due to secondary infection of the leproma by various bacterial agents. Leprosy was for centuries confused with other diseases in which ulceration and mutilation are features. The value of mercury in differentiating syphilis, the recognition of the importance of anaesthesia in this disease, together with the discovery of the bacillus of leprosy and of the etiological factors of several other confusing diseases, have made of leprosy one of the easiest of all diseases to diagnose correctly. It is, however, essentially a laboratory diagnosis.