I showed the case to the Academy of Pathological Science, where two general surgeons who examined the case advised against extirpation of the tumor, because of its close proximity to the important blood vessels and nerves of the neck, an opinion I entirely coincided with, because of seeing two similar cases before. This agreement decided me in determining to try the mixed toxins as the treatment promising the best results for the patient.
April 4. Commenced injections with one-quarter of a drop. I diminished the initial dose one-half because Dr. Coley personally advised it, as he thought the possible reactionary local swelling might seriously interfere with respiration.
April 14. The dose was increased one-quarter drop each day to date—when she took only two drops, because it was deemed advisable to omit treatment two days during menstruation on account of great weakness of patient.
April 20. Increased dose half drop per diem—on 16th and 19th treatment omitted on account of debility—dose 4 drops, which dose was continued till April 23, when on account of the temperature twice having risen to 103° F. and menorrhagia having supervened only ten days after previous regular menstruation, I thought it prudent to reduce dosage to 3½ drops, which was continued until April 26. Examination of pharynx to-day for first time showed a decided diminution in the congested appearance and size of the tumor. Formerly the tumor pushed the posterior pillar forward, so that, if the pillar could not have been lifted away from swelling by the ring probe, it would have seemed to be part of it; while to-day a small space could be distinguished between the tumor and the pillar. Dosage 4 drops.
In résumé, I would call attention to the apparent susceptibility of the patient to the toxin. Because, although she never received over half the maximum dose, the following reactionary symptoms developed: Of the seventeen days on which full records were kept, on thirteen she had chills after every dose; there were muscular pains throughout the left side, occasionally extending to the right—one-third of the time the patient was nauseated, and three times vomited—the average temperature was 100.8° F.; twice it did not rise at all after injections of ½ or 2½ drops. ’Tis well to bear in mind that chills very seldom occur after the third injection.
Finally, I wish to thank Dr. Clausen, resident physician, who carried out most of the treatment while the patient was at the Ophthalmic Hospital; also Dr. Bernard Clausen, who continued it after she returned home.
REPORT ON “HENPUYE” IN THE GOLD COAST COLONY.[[3]]
BY ALBERT J. CHALMERS, M. D., VICT., F. R. C. S. ENG.
Henpuye, or dog nose, is a disease frequently met with in the Gold Coast Colony and in certain portions of its Hinterland. The hideous deformity of the face which it causes is very striking to anyone who has lived in this part of West Africa. It is also known on the French Ivory Coast under the name of “goundu” or “anakhre,” but “henpuye” is the native name (Appolonian) for the disease on the Gold Coast. The peculiar nature of the disease and the fact that, as far as I could find, very little was known as to its nature led me to make the inquiries which are now embodied in this report. I regret very much that I am unable to refer to original papers on the subject or to be certain that I have the full literature, but my excuse is that libraries do not exist in West Africa. The only references which I have met with are those mentioned in Dr. Patrick Manson’s work on “Tropical Diseases” (p. 594), and they are those of (1) Professor Alexander Macalister (Royal Irish Academy, 1882), (2) Surgeon J. J. Lamprey, A. M. S. (Brit. Med. Jour., vol. ii., 1887), (3) Dr. Henry Strachan (Brit. Med. Jour., vol. i., 1894), and (4) Dr. Maclaud (Archives de Médecine Navale, 1895). It is by the kind permission of the Governor of this colony, Sir Frederick Hodgson, K. C. M. G., that I am allowed to publish this report. I am much indebted to Captain Armitage for his kindness in giving me information with regard to the different places in which he has noticed this disease in his travels, for drawing my attention to notes of the late Mr. Ferguson on the presence of the disease in Akim and Kwahu, and for making a painting of an advanced case of the disease; also to Dr. Henderson, the chief medical officer of the colony for many kind suggestions: and, lastly, to Mr. Crowther, draughtsman in the Public Works Department, for supplying me with a map of the colony and its Hinterland. The description of the disease will be divided into the following headings: (1) the General Description of the Disease; (2) the Description of Cases of the Disease; (3) the Treatment; (4) the Morbid Anatomy; (5) the Ætiology; and (6) the Geographical Distribution.