I have attempted to reduce these swellings by the administration of iodide of potassium, but have not met with any success. The only treatment appears to be the removal by operation. The method I adopt is as follows. The eyes being protected by a pad over each, an incision is made along the long axis of the tumor and the skin is freed on all sides so that its base is exposed. If the swelling is very small in a child it may be necessary to make a cross cut through the skin as well, in order to get sufficient room to work in. The bone being exposed, a portion of the swelling can easily be cut away by bone forceps, because it is very soft. If large, a few nicks with a Hey’s saw are found most useful in enabling a large portion of the mass to be removed entire. After as much has been removed as possible with the bone forceps, more may be got away by means of the gouge or the gouge forceps or the nibbling forceps. I have experienced difficulty in removing the deeper portions, particularly those close to the orbit. I need hardly say that in the latter the eye has to be carefully guarded from injury. After removal of the bone the wound is well washed out with an antiseptic lotion. The bleeding is slight and is easily controlled by pressure. The wound is closed by a continuous suture and it heals up readily.
THE MORBID ANATOMY.
I have never had any chance of examining the growth post mortem, but the portions which I have removed en masse by operation have enabled me to make some investigations. The periosteum strips off readily, and under this is a thin shell of compact bone, which appears somewhat ridged on the side towards the periosteum. The rest of the tumor consists of cancellous bone. The whole swelling cuts readily with bone forceps and consists of quite soft bone. On making microscopical preparations there were signs of ossification in membrane proceeding under the periosteum, and the rest appeared like ordinary wide-meshed cancellous bone. The whole process appeared to be that of a slow “osteoplastic periostitis.”
ÆTIOLOGY.
Two views on the ætiology of this disease have been brought forward up to the present time, as far as I know—viz., that the swellings were of a racial character and that the process was started by the larva of some insect. With regard to the first I have only to mention that the disease is found in Ashantis, Grunshis, Fantees, Abantas, the Ga people, etc., races quite different from one another, to show that this cannot be entertained. As to the second, I have never met with evidence which would support the idea that the disease was started by a larva. On the other hand there is always the history of yaws and of the tumor starting during the attack of yaws—i. e., during the period of eruption or soon after. Then, again, the patients complain of pain in the nose with, in some cases, distinct history of a sore and sometimes discharge preceding the swelling. This might be due to some irritation or ulceration of the nasal mucous membrane by the yaws. I have never had the opportunity of examining any person at this stage of the disease, but in the more developed cases I have examined the nose for marks or signs of old ulceration, but have not found them. If, however, the nasal process of the superior maxilla be examined a few foramina are to be seen, and these are often joined together by a small groove indicating the position of a bygone suture. The foramina are for small bloodvessels, which are said to communicate with those of the mucosa of the nose. The site of these foramina is the situation where henpuye starts, and I venture to bring forward the theory that the causation of this peculiar disease is due to an osteoplastic periostitis brought about by the absorption of the poison of yaws from the nasal mucous membrane through the small vessels (or lymphatics) keeping open the foramina which indicate the suture above mentioned.
THE GEOGRAPHICAL DISTRIBUTION.
I am only aware of cases reported from the Gold and Ivory Coasts of West Africa and the West Indies. I never met with it in Mamprusia, nor have I met any trader coming from Moshi with it, nor have I met with it in Fra Fra, and I can find no one who has seen it in the eastern parts of the colony. But in the following districts it has been noted: Ahanta, Appolonia, Fantee, Accra, Aquapim, Akim, Assin, Sefwhi, Ashanti, Attabubu, Kwahu, Kintampo, Berekum, Gaman, the Neutral Zone, and Wassaw. It is perhaps most common in the Sefwhi, Wassaw, and Appolonia districts which adjoin the French Ivory Coast, where cases are also known.
I look upon henpuye as a localized osteoplastic periostitis in the region of the nasal process of the superior maxilla, generally symmetrical, due to yaws, and found among the natives of West Africa and the negroes of the West Indies.
THE MADDOX ROD OR THE PHOROMETER; WHICH?
In the last issue of the Journal there appeared an abstract with the above title, and believing the subject to be of much interest at the present time, our readers have been invited to send us their opinions on the matter, as based on the experience obtained in practice. The communications below have been received and are presented in the order of their reception. We shall be glad to hear from any physicians who are interested [Ed.].